Pathology laboratories across the country have been faced with numerous challenges brought on by the COVID-19 pandemic, including working longer hours and struggling to find ways and means of turning out test results.
At a press conference during the 2020 virtual meeting of the College of American Pathologists (CAP), researchers discussed survey results indicating that work weeks for some pathologists have lengthened by 12 hours thanks to the backlog and need for COVID-19 testing.
In reporting the results of the surveys among pathologists in April, June, and September, Thomas M. Wheeler, MD, professor of pathology and immunology at Baylor College of Medicine in Houston, told 51˶ that in one case, a technician was moved into a hotel next to the hospital in case he was needed to run testing on a patient who was brought in for non-COVID-19 reasons.
Wheeler explained that any patients who presented at the hospital, even those for non-COVID illness or injury, had to be treated as if they were carrying the deadly virus. That meant treating clinicians needed personal protective equipment and the patient had to be isolated until a test could clear him -- hence, the technician who lived 35 miles away was moved to the hotel room where he could be available 24/7.
"The bottom line results of the surveys of laboratory directors performed in April and June is that most College of American Pathologists-accredited laboratories are providing COVID-19 testing -- about 76% of responding labs in our June survey," Wheeler said.
He added that "60% of those labs report having more than one type of testing platform. About 55-65% of laboratories report substantial difficulties, however, in getting supplies, like test kits, swabs, and transport media. Nearly all pathologists report that non-COVID-19 testing volume for their laboratories is down substantially compared with the same period in 2019."
Wheeler noted that in a survey performed in September, 70% of pathologists reported higher stress levels than before the pandemic. "Also in that survey, 20% of respondents reported that they have been working more hours since the pandemic began -- an average of 12 hours increase over the previous time period before COVID," he said. "There were some pathologists who were working less if they were involved with anatomical pathology but there were many pathologists in the clinical laboratories who had to work many more hours."
"It is no secret that the COVID-19 pandemic has tremendously affected laboratory workers all across this country," said Patrick Godbey, MD, CAP's president and medical director of Southeastern Pathology Associates in Brunswick, Georgia.
"Coming from a small hospital in South Georgia, ideally when you do a test, you do it on one platform and you duplicate that platform," Godbey said. "It's cheaper both from the maintenance standard point and the medical laboratory side, the supply chain is through one source, and reporting is through one mechanism."
When more than one platform is used for testing, he said, "You have to bring in reagents from several different sources, and there are all sorts of different reporting mechanisms. We have maintenance contracts on different machines. It is much less efficient, but we have to shop supplies. Today we can get supplies from one manufacturer, tomorrow we may get supplies from another manufacturer."
"Still, for every one test I can do in house, I still have to send out another one," he said, "and that means our patients have to wait. It has been amazing to see how our laboratories have coped with the testing demand."
"Things are better now than they were in April and June, but year-to-date anatomic pathology testing volume is down almost 25%, and non-COVID-19 clinical pathology testing is down an average of 16%. Also of note, the stretches on the laboratory work force have gotten worse since April and June as this crisis continues, [with] such things as burnout, furloughs, [and] staffing shortages contributing to that stretch level," he added.
Another press conference panelist, Kathleen G. Beavis, MD, professor of pathology at the University of Chicago, said similar problems exist in her area. "We have seen similar problems with burnout and fatigue among our laboratory staff, but one thing that has been very rewarding for us has been the ability of our institution to dedicate ourselves and our resources to bring the testing to the communities. Early on we focused on bringing testing to the nursing homes in the underserved areas of Chicago's south end and west sides."
"Our laboratory is usually very aggressive in producing testing for our patients, but we have blown all the records in terms of the number of things we have looked at, number of kits we have had to validate, and how creative we have had to be to perform testing for poor patients in our community," Beavis said. "The supply challenges are not just limited to COVID but we are finding them in our regular microbiology media -- blood plates, collection devices for sexually transmitted diseases. We are struggling with them much more than we are with COVID-19 at this point."
Another panelist, Joseph M. Sanfrancesco, MD, a pathologist at Coastal Pathology of Charleston, South Carolina, said, "We have the very same types of problems in the community hospitals as being seen in academia. This pandemic has shown us that we all face very similar challenges."
"We talk about physician burnout, and healthcare provider burnout, but these machines can get burned out, too, because they are running at such a constant rate," he added.
Disclosures
None of the doctors disclosed any relevant relationships with industry.
Primary Source
College of American Pathologists
"COVID-19 impacts on CAP-accredited laboratories: economic and workforce challenges, current perspectives and unique challenges in smaller communities" CAP 2020.