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Strengths of the Northwell Health Laboratory Service Line: Maintaining Performance During Threatened Interruptions in Service.

ABSTRACT: From 2009 to 2015, the laboratories of the 19-hospital North Shore-LIJ Health System experienced 5 threatened interruptions in service and supported 2 regional health-care providers with threatened interruptions in their laboratory service. We report our strategies to maintain laboratory performance during these events, drawing upon the strengths of our integrated laboratory service line. Established in 2009, the laboratory service line has unified medical and administrative leadership and system-wide divisional structure, quality management, and standardization of operations and procedures. Among many benefits, this governance structure enabled the laboratories to respond to a series of unexpected events. Specifically, at our various service sites, the laboratories dealt with pandemic (2009), 2 floods (2010, 2012), 2 fires (2010, 2015), and laboratory floor subsidence (2013). We were also asked to provide support for a regional physician network facing abrupt loss of testing services from closure of another regional clinical laboratory (2010) and to intervene for a non-health system hospital threatened with closure owing to noncompliance of laboratory operations (2012). In all but a single instance, patient care was served without interruption in service. In the last instance, fire interrupted laboratory services for 30 minutes. We conclude that in a large integrated health system, threats to continuous laboratory operations are not infrequent when measured on an annual basis. While most threats are from external physical circumstances, some emanate from unexpected administrative events. A strong laboratory governance mechanism that includes unified medical and administrative leadership across the entirety of the laboratory service line enables successful responses to these threats.

SUBMITTER: Balfour E

PROVIDER: S-EPMC5497918 | biostudies-literature | 2016 Jan-Dec

REPOSITORIES: biostudies-literature

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Strengths of the Northwell Health Laboratory Service Line: Maintaining Performance During Threatened Interruptions in Service.

Balfour Erika E Stallone Robert R Castagnaro Joseph J Poczter Hannah H Schron Deborah D Martone James J Breining Dwayne D Simpkins Henry H Neglia Tom T Kalish Paul P Crawford James M JM

Academic pathology 20160101

From 2009 to 2015, the laboratories of the 19-hospital North Shore-LIJ Health System experienced 5 threatened interruptions in service and supported 2 regional health-care providers with threatened interruptions in their laboratory service. We report our strategies to maintain laboratory performance during these events, drawing upon the strengths of our integrated laboratory service line. Established in 2009, the laboratory service line has unified medical and administrative leadership and syste ...[more]

PMID: 28725768

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Project description:BackgroundThe authors aim to evaluate the perception, strengths, and challenges in the implementation of "Clinical Laboratory Shadowing" as an elective module for third-year professional medical students.MethodsClinical Laboratory shadowing is an elective module designed by the faculty of Biochemistry for Phase III part-2 medical students. The elective comprises modules explaining the functioning of the Biochemistry Laboratory in a hospital. The students are provided insights into the different processes involved in laboratory testing. They are taught about total quality management of the Biochemistry Laboratory. Thirteen students from Batch 2019 and eight students from Batch 2020 volunteered to attend the elective. Students' feedback regarding the learning was analyzed with the help of a questionnaire. Pre-test and post-test questions were evaluated to test the knowledge gained during the elective. Two focus group discussions were conducted regarding the benefits and areas for improvement for the elective.ResultsFollowing the elective module there was a significant improvement in the test score compared to baseline. A majority (84-95%) of students perceived that the shadowing elective was well planned, and materials were well prepared, there was appropriate engagement with the facilitators, gained knowledge on the principles of total quality management, good laboratory practices, disease process, and diagnosis. Most (53-74%) of the students felt that this elective was not monotonous and not difficult. Around 84-95% of students felt that this elective module enhanced the importance of interprofessional communication and teamwork. Moreover, through focused group discussions, several recurring themes emerged. Among these, the scope for improvement within the module is profound. The faculties were of the opinion that the shift from conventional training to competency-based learning was effectively embraced by the students, underscoring the importance of consistent small group activities in the module to enhance the skills of Good laboratory practices. The students expressed a desire for additional clinical correlation and interpretation classes in the elective module, showing their preference for student-centred clinically oriented learning.ConclusionThe current study concludes that including an elective module on Clinical laboratory shadowing is an overall positive experience for medical students in enhancing their knowledge of basic sciences and application of the concepts in diagnosing cases. This elective may be desirable to adopt in other medical colleges in India.

Project description:PurposeWar negatively impacts health professional education when health care is needed most. The aims of this scoping review are to describe the scope of barriers and targeted interventions to maintaining health professional education during war and summarise the research.MethodsWe conducted a scoping review between 20 June 2018 and 2 August 2018. The search was restricted to English publications including peer-reviewed publications without date ranges involving war and health professional education (medical school, residency training and nursing school), with interventions described to maintain educational activities. Two independent reviewers completed inclusion determinations and data abstraction. Thematic coding was performed using an inductive approach allowing dominant themes to emerge. The frequency of barrier and intervention themes and illustrative quotes were extracted. Articles were divided into modern/postmodern categories to permit temporal and historical analysis of thematic differences.ResultsScreening identified 3271 articles, with 56 studies meeting inclusion criteria. Publication dates ranged from 1914-2018 with 17 unique wars involving 17 countries. The studies concerned medical students (61.4%), residents (28.6%) and nursing students (10%). Half involved the modern era and half the postmodern era. Thematic coding identified five categories of barriers and targeted interventions in maintaining health professions education during war: curriculum, personnel, wellness, resources, and oversight, with most involving curriculum and personnel. The distribution of themes among various health professional trainees was similar. The frequency and specifics changed temporally reflecting innovations in medical education and war, with increased focus on oversight and personnel during the modern era and greater emphasis on wellness, curriculum, and resources during the postmodern era.ConclusionsThere are overarching categories of barriers and targeted interventions in maintaining health professional education during war which evolve over time. These may serve as a useful framework to strategically support future research and policy efforts.

Project description:PurposeSouth Africa's National Health Laboratory Service (NHLS) National HIV Cohort was established in 2015 to facilitate monitoring, evaluation and research on South Africa's National HIV Treatment Programme. In South Africa, 84.8% of people living with HIV know their HIV status; 70.7% who know their status are on ART; and 87.4% on ART are virologically suppressed.ParticipantsThe NHLS National HIV Cohort includes the laboratory data of nearly all patients receiving HIV care in the public sector since April 2004. Patients are included in the cohort if they have received a CD4 count or HIV RNA viral load (VL) test. Using an anonymised unique patient identifier that we have developed and validated to linked test results, we observe patients prospectively through their laboratory results as they receive HIV care and treatment. Patients in HIV care are seen for laboratory monitoring every 6-12 months. Data collected include age, sex, facility location and test results for CD4 counts, VLs and laboratory tests used to screen for potential treatment complications.Findings to dateFrom April 2004 to April 2018, 63 million CD4 count and VL tests were conducted at 5483 facilities. 12.6 million unique patients had at least one CD4 count or VL, indicating they had accessed HIV care, and 7.1 million patients had a VL test indicating they had started antiretroviral therapy. The creation of NHLS National HIV Cohort has enabled longitudinal research on all lab-monitored patients in South Africa's national HIV programme, including analyses of (1) patient health at presentation; (2) care outcomes such as 'CD4 recovery', 'retention in care' and 'viral resuppression'; (3) patterns of transfer and re-entry into care; (4) facility-level variation in care outcomes; and (5) impacts of policies and guideline changes.Future plansContinuous updating of the cohort, integration with available clinical data, and expansion to include tuberculosis and other lab-monitored comorbidities.

Project description:ImportanceStay-at-home orders, site closures, staffing shortages, and competing COVID-19 testing and treatment needs all potentially decreased primary care access and quality during the COVID-19 pandemic. These challenges may have especially affected federally qualified health centers (FQHCs), which serve patients with low income nationwide.ObjectiveTo examine changes in FQHCs' quality-of-care measures and visit volumes in 2020 to 2021 vs prepandemic.Design, setting, and participantsThis cohort study used a census of US FQHCs to calculate changes in outcomes between 2016 and 2021 using generalized estimating equations.Main outcomes and measuresTwelve quality-of-care measures and 41 visit types based on diagnoses and services rendered, measured at the FQHC-year level.ResultsA total of 1037 FQHCs were included, representing 26.6 million patients (63% 18-64 years old; 56% female) in 2021. Despite upward trajectories for most measures prepandemic, the percentage of patients served by FQHCs receiving recommended care or achieving recommended clinical thresholds showed a statistically significant decrease between 2019 and 2020 for 10 of 12 quality measures. For example, declines were observed for cervical cancer screening (-3.8 percentage points [pp]; 95% CI, -4.3 to -3.2 pp), depression screening (-7.0 pp; 95% CI, -8.0 to -5.9 pp), and blood pressure control in patients with hypertension (-6.5 pp; 95% CI, -7.0 to -6.0 pp). By 2021, only 1 of these 10 measures returned to 2019 levels. From 2019 to 2020, 28 of 41 visit types showed a statistically significant decrease, including immunizations (incidence rate ratio [IRR], 0.76; 95% CI, 0.73-0.78), oral examinations (IRR, 0.61; 95% CI, 0.59-0.63), and supervision of infant or child health (IRR, 0.87; 95% CI, 0.85-0.89); 11 of these 28 visits approximated or exceeded prepandemic rates by 2021, while 17 remained below prepandemic rates. Five visit types increased in 2020, including substance use disorder (IRR, 1.07; 95% CI, 1.02-1.11), depression (IRR, 1.06; 95% CI, 1.03-1.09), and anxiety (IRR, 1.16; 95% CI, 1.14-1.19); all 5 continued to increase in 2021.Conclusions and relevanceIn this cohort study of US FQHCs, nearly all quality measures declined during the first year of the COVID-19 pandemic, with most declines persisting through 2021. Similarly, most visit types declined in 2020; 60% of these remained below prepandemic levels in 2021. By contrast, mental health and substance use visits increased in both years. The pandemic led to forgone care and likely exacerbated behavioral health needs. As such, FQHCs need sustained federal funding to expand service capacity, staffing, and patient outreach. Quality reporting and value-based care models must also adapt to the pandemic's influence on quality measures.

Dataset Information

Strengths of the Northwell Health Laboratory Service Line: Maintaining Performance During Threatened Interruptions in Service.

Publications

Strengths of the Northwell Health Laboratory Service Line: Maintaining Performance During Threatened Interruptions in Service.

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