Swine Flu Tests Could Swamp Diagnostic Labs
Concerns about a swine flu outbreak this fall are spreading to the nation's diagnostic laboratories, which could see a big surge in their testing workload this fall.
According to several laboratory professionals affiliated with the American Society for Clinical Pathology, a large spike in swine flu screenings could clog a lab system already struggling with a shortage of workers. Such swine flu screenings, they said, could slow down testing for other diseases, potentially putting some patients at risk.
"There are now thousands of different tests that doctors can order," said Dr. Michael Laposata, chief of pathology at Vanderbilt University Hospital in Nashville. "The whole issue of sheer workload and labor shortage is playing out in a big way with this H1N1 virus."
At Vanderbilt, a staff of roughly 300 lab technologists and other workers already has been processing an average of 150 to 200 flu tests -- for both swine and regular flu -- a day, most of them from the hospital's pediatric emergency room, Laposata said.
If there's a significant surge in H1N1 swine flu tests, overtime budgets could be stretched at many hospitals, especially small ones, he added.
"Automation in the lab has certainly helped us increase efficiency and accuracy, but a hospital lab is not a big machine," said Laposata, adding that testing could further be compromised if lab staffs fall ill during a swine flu epidemic. "What happens if these techs get sick? Instead of 300 people, we have 40 people. I'm in big trouble."
There are several tests for H1N1, the virus that causes swine flu. They range from rapid influenza diagnostic tests, which can detect influenza viral nucleoprotein antigen in as little as 30 minutes, to more sophisticated polymerase chain reaction assays. All require lab personnel to administer and review results, Laposata said.
At New York University Langone Medical Center, lab workers handled an increase of as many as 300 swine flu tests a week during the initial epidemic in the spring and early summer, according to Irina Lutinger, the medical center's senior administrative director of clinical laboratories. If swine flu becomes a full-fledged epidemic this fall and winter, her staff of 45 in the lab's microbiology department could be forced to handle thousands of H1N1 tests per week, she said.
Much of the concern among lab directors owes to the fact that since at least the 1990s, fewer people are choosing lab work as a career. Even if they do, fewer training programs are around to serve students, experts say.
Citing federal statistics, the American Society for Clinical Pathology says that 138,000 new laboratory professionals will be needed nationwide by 2012, but fewer than 50,000 will be trained. California and other Far West states are weathering a 53 percent shortage of medical technologists in hospitals, commercial labs and other diagnostic facilities; followed by 46 percent in Arkansas, Louisiana, Oklahoma and Texas, and 42 percent in the Northeast.
"When (a lab worker) leaves, you get hit," Lutinger said. "We try to automate, but you need human intellect."
Hospitals like Lutinger's are coping with the potential surge in swine flu tests by drafting contingency plans. During a serious outbreak, all medical tests would be reviewed and prioritized, and excess tests would be sent to outside labs for analysis, she said.
There's also a growing trend among medical professionals and local health departments to recommend H1N1 flu tests only for the sickest patients or for particular surveillance studies.
Emergency room staffers at Montefiore Medical Center in New York City, for example, generally reserve swine flu testing for patients who clearly need hospitalization or have serious underlying health problems. Patients who are younger and otherwise healthy are treated and then encouraged to stay home, said Michael Levi, director of clinical microbiology services at the hospital.
Levi said he has no doubt his staff is up to the task, but "if there is the surge issue, that can stress out people."