Resilience is the key to decode lab diagnostics during COVID
Coronavirus disease 2019 (COVID-19) is a global threat to healthcare and patient safety, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Laboratory journey may not always come with a planner and roadmap. Year 2020 has had many twists and turns in the path, from daily challenges to huge impact in the healthcare domain and world economy. The road ahead of 2021 is also not clear. No clear directive, no roadmap can be drawn in this uncertain time.
As unexpected and unprecedented healthcare need pushes cost-burden onto hospital systems, laboratories are faced with budget constraints while managing demand for higher quality and competitive turnaround time (TAT).
Efficiently managing these intensifying pressures is critical to the sustainability of laboratory management, and requires new strategies to reduce cost burden, while maintaining quality.
Total cost of ownership (TCO) is a concept that can help laboratories and hospitals identify factors that drive increased costs, with the goal of identifying the source of operational inefficiencies throughout the laboratory operations and improving productivity.
The impact of direct and indirect costs on a laboratory’s budget can be significant, and proper management of these costs is crucial to making operational improvements. By taking a more holistic approach to managing your laboratory operations, you can have a dramatic impact on the performance of your laboratory and in turn deliver greater value to your healthcare institution. One needs to use current state value stream maps to identify opportunities for building resilient diagnostic strategies in the laboratory process flow.
Few measures are discussed below to shrink the timeline of ongoing pandemic, combating the current challenges with speed, efficiency and flexibility, as well as to be ready, to respond to future pandemics. These measures are critical elements of mitigating the health, economic and social burdens of COVID-19 pandemic.
Scaling up the capacity of testing for COVID-19. There are two main testing technologies: molecular assays, which identify viral genetic material and signal the presence of a viral infection, and immunoassays, which identify antigens or antibodies. Scaling up the capacity of testing for COVID-19 diagnosis by reverse transcripase polymerase chain reaction (rRTPCR) and also rapid antigen testing, if required, is the need of the hour.
Innovative and flexible approaches are must to maximize the diagnostic capacity. Also scaling up the antibody testing for sero surveillance and mass screening is required. This will ensure that high throughput of coronavirus test results are delivered in faster turnaround time (TAT) and accurately, allowing people to either quarantine or get back to work.
The critical role of laboratory medicine in this pandemic extends far more than etiological diagnosis of COVID-19, by rRTPCR. Routine laboratory monitoring of COVID-19 patients through testing is critical, for assessing disease severity and progression, as well as monitoring therapeutic intervention.
The main laboratory changes encompass an array of increased inflammatory biomarkers, coagulation parameters, tissue-specific tissue injury indicators (liver, kidney, cardiac) and derangement of the complete blood count. Based on severity of disease, host inflammatory response to virus may lead to cytokine storm that can cause multi-organ damage.
Bridging the supply–demand gap. The challenges in the testing process worldwide suggest what might be done to focus on the opportunities and bridge the supply–demand gap. Involvements require different level of investments: both short-term measures and long term measures for incremental in improvements in diagnostic care domain.
Never delay your testing and other health screening. COVID-19 is having a major hit on the healthcare sector, patient care. The impact of COVID-19 on patient care worldwide is also highlighted in one study, where overall 60.9 percent reported that clinical activity was reduced at the peak of the pandemic, while nearly two-thirds showed under-treatment as a major concern and there is significant drop in clinical trials.
Another study showed that the vast majority reported facing challenges, in providing care during the pandemic, with alarming increase in cases of coronavirus among their patients and staff. While half reduced services pre-emptively, others were forced to do so after being overwhelmed by the situation, or following a shortage of personal protective equipment, staff and medicine. We need to create awareness among the chronic patient group (cardiac, cancer, diabetes and general illnesses) about the need to get periodic blood tests, which might be pending due to COVID pandemic.
Introducing total laboratory automation and AI in routine laboratory testing. Rapid changes in diagnostic sector coupled with parallel advances in technology have stimulated the evolution of approaches for total laboratory automation (TLA), Artificial Intelligence (AI) and robotic elements in routine laboratory process flow. These measures offer promise in streamlining the clinical laboratory process flow. Increasing cost-containment pressures make the application of this technology highly approachable.
Support and connect with team. Resilience and humanity hold the key to shorten the curse of the current crisis.
Therefore, the roadmap for laboratory medicine, involves strategies for harmonizing, communicating and integrating with all stakeholders, like, clinicians, diagnosticians and IVD industry, in order to formulate guidelines for assisting in correct measurement, diagnosis and management of diseases and reduce the cost burden, while maintaining quality. In this pandemic, processes need to be streamlined in Laboratory Medicine to ensure provision of reliable and timely test results, appropriate alliance with brain to brain loop, thus enhancing quality of care and patient safety.
In recent decades, both International Federation of Clinical Chemistry and Laboratory Medicine, American Association of Clinical Chemistry (AACC), ICMR in India and several other national and international societies of laboratory physicians are playing an active role for showing directives for testing and management of COVID-19, as well as standardization and harmonization of tests, methods, cut off and laboratory practices.
During the pandemic, though the pressure on healthcare professionals and systems is overwhelming as a result of the growing global burden, we have become stronger than before to fight the storm, to curtail the tail of pandemic and to get ready to fight any future pandemic.