Missouri
Courier
In Missouri, transit time means time from collection to when laboratory testing begins. Smaller birthing facilities were using the US Postal Service (USPS) to deliver 1-2 samples at a time, and some hospitals were unable to verify that the laboratory received the samples, resulting in official transit times of 5-9 days. To help alleviate this issue, the laboratory contacted the smaller birthing facilities who were utilizing USPS, and identified the closest county health department, which would serve as a drop-off point for samples. The courier would then visit every county health department, which were already included in the contracted courier deliveries, to collect the samples and return to the laboratory around midnight. After these smaller birthing facilities started self-transporting to the nearest county health department the delivery occurred within the same-day and testing could begin the next day.
Missouri has 13 holidays and many of these occur on Monday, causing frequent three day weekends. The combination of holiday closure and no Sunday courier meant that the lab would not get three days of samples until Tuesday or Wednesday. Starting in 2015, the NBS program received additional funding from the legislature that allowed for the addition of a Sunday courier and to add eight more birthing facilities to the pickup routes. By expanding the courier to operate one day before the lab meant that weekend babies were able to be tested on Monday instead of Tuesday.
Additionally, the laboratory developed a secure portal where submitters can track their samples and see the results in real-time. This portal has been a very helpful tool as submitters can verify each day that the lab received all the specimens from their facility. If the specimens are not marked as received in the portal, the submitter should contact the laboratory and both agencies will conduct an investigation. The courier expansions in conjunction with expanded Monday through Saturday lab operating hours resulted in an improved transit time from 61% of specimens received within three days of collection to 90%.
Extended Hours
In October 2015, the NBS laboratory received funding ($290,000 per year) to implement Saturday and holiday testing and courier expansions, which was spearheaded by the legislature. To accommodate new hours on Saturdays and holidays (except for Thanksgiving, Christmas Day and New Year’s Day), a skeleton crew of 7-8 scientists and two office support staff would be needed. Staff assignments for these days were 100% voluntary but one full-time employee at the manager level was required to supervise on Saturdays and holidays. The two newest staff members are required to work Tuesday through Saturday until attrition allows them to move to a Monday through Friday schedule. They may volunteer to work holidays.
In addition to the new hires, five adjunct employees may volunteer to work Saturdays and holidays making straight time pay under a special classification called secondary assignment. This is not considered overtime, but instead, pay is added to their regular paycheck. Staff from NBS, microbiology, chemistry and molecular staff are each trained on a single platform and asked to work at least one Saturday or holiday per month to maintain testing method proficiency.
Costs
The total cost to expand courier and operating hours came to $286,000 per year, which equates to about $3.00 added to the NBS fee. The breakdown includes:
- $6,000/year for holiday courier
- $36,000/year for Sunday courier
- $44,000/year to add eight more birthing facilities to the courier route
- $200,000 for Saturday and holiday testing
The Saturday and holiday staff are not paid overtime, but receive a special classification called a “secondary assignment.” Their hours are designated separately on their paycheck.
Laboratory Access Portal
Missouri’s laboratory access portal, a secure website for tracking of samples, allows users to view laboratory results in real time. Submitters at hospitals can verify
that the laboratory has received their samples, and can print and save reports. If samples have not been received, submitters can contact the laboratory and conduct an investigation. The few times this has occurred, the samples have been located at the hospital. Missouri’s NBS reporting system is paperless, with the exception of reports to physicians which are distributed in hard copy, and it has significantly reduced the number of calls requesting reports.