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Trimming the fat from the budget; this blood bank achieved surprising savings by adhering to a new fiscal regimen: the DRG diet, exercise, and checkup plan.

Cost control, DRGs, financial forecasting, productivity. It's hard to escape hearing those words in any conversation about lab management, usually accompanied by moans and Cassandralike predictions of doom. In the blood bank of this 440-bed hospital, however, the atmosphere is a little more optimistic.

Unlike some of our more fortunate counterparts in other hospitals, we have had to work with a lean budget for several years, so we are used to a pervasive cost awareness. Our philosophy is a simple one. By looking hard at our procedures, we have always been able to find new economies while maintaining quality service.

Our three chief weapons in this fat-cutting crusade are diet, exercise, and checkups. Here are some of the ways they can help any laboratory deliver effective service for less.

First, diet! Cut every scrap of waste from your section. Just don't become anorectic--spare the elements that are essential for a healthy operation.

We found that reagent red blood cells had been running up a hefty bill, so we examined their costs and patterns of utilization. Under a previous supervisor, each technologist and student--13 individuals--had his or her own typing tray of reagent sera and cells. This practice was purportedly begun to avoid contamination of reagents, but it resulted in the purchase of 26 antibody detection sets and 28 reverse grouping sets per month.

Inspection revealed students and technologists were discarding outdated vials that were more than half full. Cutting the reagent order seemed only logical. We did it very gradually, while closely monitoring the reagent quality control of the shared sets. After a year, we reduced the order from 26 and 28 reagent red cell sets per month to 10 and 10--and our QC records documented that there were no problems with tests due to contamination or reagent failure. As Figure I shows, this one simple dieting measure resulted in savings of more than $3,000 after two years, without sacrificing quality in any way.

Other measures followed, such as limiting the purchase of Coombs control cells. The blood bank bought 384 vials of the control cells in 1981. This year, after several years of successively smaller orders, we expect to consume only 234 vials.

Another trimming measure saved the blood bank at least $1,000 a year by eliminating routine anti-CDE testing on Rh-negative units to be transfused except when patients demonstrate an antibody to those antigens. We have also implemented minimum testing for typing confirmation of incoming units of blood. By cutting the extended typings, we have saved about $750 a year--again, with no increased risk to patients.

This year, we anticipate productivity benefits and reagent savings from a plan not to perform routine elutions on cord blood of type A or B newborns who have a positive direct Coombs test and were born to group O positive mothers. Our own findings, supported by a search of the literature, convinced the medical staff that the costly and time-consuming elutions were redundant under these circumstances.

The point for any laboratory section is this: Take a good, hard look at your routines. Are you performing a test only because you have always performed it? Are you performing more tests than are really necessary? Give your section the pinch test, and you'll find that it is probably carrying some excess weight.

Since personnel costs make up a big chunk of the hospital's total budget, increased productivity is another key to getting more for every dollar. That brings us to the second part of our plan--exercise. You have to move smarter and faster to push each section's productivity to the maximum. We decided to examine our productivity by shift and to dovetail these data with a thorough workload analysis.

We tracked each shift as accurately as possible with CAP workload recording. At first, we were amazed at the productivity differences among the shifts: an average of only 34 units per hour for day-shift staff members, 42 for the evening shift, and a dismal 25 for the night shift.

After taking a closer look at the actual tasks being performed, we redistributed some routine testing. Prenatal specimens, which have a different protocol from routine type and screens, were reassigned to the night shift, instead of being performed as they arrived in the blood bank. Night personnel also assumed quality control tasks at the end of their shift. And no longer did the overworked evening technologists perform preadmission testing. Even though these specimens entered the lab during their work hours, they were now saved for the day shift.

This new arrangement left the evening shift free for late pre-operative and emergency compatiability testing, the workload level for which it was staffed. Meanwhile, the night shift still had sufficient slack time to cover Stat orders, along with additional tasks to occupy it between emergencies. Productivity figures reflected the reshuffling, changing to 36 for the day shift, 45 for the evening shift, and 35 for the night shift. The recent acquisition of an automated cell washer has given yet another boost to section productivity.

Incidentally, we have found that a staggered system of day and evening shifts, based on a close scrutiny of work flow patterns, is the most cost-effective way to use our personnel. One technologist arrives in the lab at 7 a.m., two arrive at 8 a.m. (after the venicpuncture team completes collection rounds), and two more at 8:30 a.m. Our full-time evening technologist arrives at 2:45 p.m. and a part-time evening technologist at 4 p.m. This overlapping coverage allows us to handle bulges in the workload and enables the shifts to share information.

The experience taught us that analyzing productivity takes a lot of time and effort but that the final results are well worth it. Since my education coordinator and I spend hours preparing lectures or teaching our medical technology students, I used specified hours--minus teaching time--to recalculate the day-shift productivity figures. Specified hourly productivity for the day shift emerged closer to 42, a far more accurate reflection of actual workload.

The third key to our fiscal fitness regimen is regular checkups. Felxibility is the key. Periodically, like a dieter experimenting with a new low-cal food, we try a new tactic to fight waste. Sometimes the results are successful, sometimes not.

Checkups can cover a broad range of expenses. For example, go through your inventory of products and reagents. Are you reordering a certain brand from force of habit or because you like the sales representative? These days, few laboratory balance sheets will allow such luxury for long.

Search out new vendors for major purchases, and compare price and quality. By switching vendors on just one high-usage item--blood administration sets--we estimated that the hospital could save at least $5,000 a year, and we are now making the switch after a thorough evaluation.

Investigate whether your section of the lab could coordinate ordering with another section to obtain bulk discounts. Group purchasing of disposables such as test tubes, slides, and pipets can achieve significant savings in a year or two. We are now trying to consolidate such orders so that each section of the laboratory buys from the same company.

The lean, mean health care economy is challenging every laboratory to keep in fighting trim. Don't moan--get in shape. You and your institution's administrators will feel better for it.
COPYRIGHT 1985 Nelson Publishing
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 1985 Gale, Cengage Learning. All rights reserved.

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Author:Martin, Deborah N.
Publication:Medical Laboratory Observer
Date:May 1, 1985
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