Texas

Staffing

The Texas Newborn Screening Laboratory changed from five to six-day operations in 2007. Five analytical staff were added to accommodate this change, resulting in a current total of 61 staff in the analytical portion of the laboratory. The laboratory is closed on most federal holidays but open on all state holidays to receive, process and test specimens. The newborn screening laboratory does not close for more than two consecutive days. Approximately 22 (of the 61) analytical staff work on Saturdays on a rotational basis. In addition, five staff work to accession the specimens and three employees do demographic information entry and print tests reports on Saturdays. Holidays are staffed to cover the expected workload.

Since the Texas laboratory began Saturday testing over a decade ago, scheduling for Saturdays has been a regular part of newborn screening program operations. The staff knows that they are expected to regularly work a Saturday shift. The staff that works on a Saturday are scheduled a flex day the following week, such that staff works a 40 hour work week. Candidates for vacancies are asked on the application and during the initial interview process about their Saturday availability. Although the staff is now accustomed to working on Saturdays and holidays, scheduling remains a challenge for managers to accommodate for time off requests, sick days, and flex days while ensuring the laboratory is sufficiently staffed.

The analytical area is composed of six teams. Each manager has a process for scheduling staff to meet each team’s needs. The maximum daily workload is posted monthly and individual teams develop and distribute work schedules approximately a month in advance. For the major holidays of Thanksgiving and Christmas, schedules and workload are determined in August/September so that teams and staff can plan for any time-off requests.

Follow-up

Short-term follow-up protocols are limited to time-critical disorders on Saturdays and holidays thereby allowing for reduced staff. The 12 NBS nurses and 3 nurse leads rotate to cover the follow-up calls and are scheduled three at a time—one metabolic nurse, one nonmetabolic nurse, and one lead nurse backup. This Saturday/holiday schedule is frequently revisited depending on expected caseload.

Vendor and IT Support

Every vendor contract requires that maintenance and support be available on Saturdays. For the internal IT help desk and laboratory application support, the NBS laboratory provides the on-call personnel with a cell phone so they can be contacted when
there is an issue. Contracts with the courier services require regular deliveries on Saturdays.

Workload

Even though the laboratory runs all screening tests on Saturdays, it does not perform all activities, such as quality assurance (QA) monthly reviews, processing parental consent forms for specimen storage/destruction, review of missed or diagnosed cases, or evaluating cutoffs. As a two-screen state, the laboratory prioritizes the first screens and depending on the quantity of specimens received there may be some second screens that will not be processed until the next business day. The laboratory processes about 2,500-2,600 samples on weekdays and generally processes a reduced workload of about 2,000 samples on Saturdays.