Timeliness Toolkit for Expanding Newborn Screening Services

Section 6: Overview of NBS Weekend & Holiday Operations

This resource is part of the Timeliness Toolkit for Expanding Newborn Screening Services. Explore the full Timeliness Toolkit for Expanding Newborn Screening Services.

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Summary

As of June  2018, 10 newborn screening (NBS) laboratories operate seven days per week and 24 operate six days per week.  See the NewSTEPs State Profiles and Infographics for up-to-date statuses and additional information related to hours of operations and weekend/holiday activities, including disorders screened.  In addition to the information collected in the State Profiles, Tables 1-5 below,  highlight state specific processes for weekend and holiday operations for participating newborn screening (NBS) programs. 

To learn more about state's implementation process for expanding newborn screening laboratory and courier operations, see the 10 case studies highlighted in the right sidebar of each toolkit section or see the compiled stories here. These narratives provide a roadmap to what and how to implement weekend and holiday operations. Use these examples and lessons learned when implementing changes in your state!

For any questions or to update your state's information, please contact Sarah McKasson.  

 

Table 1: Weekend and Holiday Specimen Delivery
StateTime of Specimen DeliveryWeekend and Holiday Delivery Notes
ARSat: 8-10 am

Delivery time between 8-10 am allows the staff to get all Saturday samples tested the same day; if received after 10 am, specimens will be tested the next business day. Depending on weekend staffing, non-time critical results may be screened too.

CASat: <10 amLab is open 7 days/week, but specimen delivery is only 6 days/week for most regional labs except for one.
COSat: 5-8 amThe cutoff time for specimens to be tested on Saturday is 8 am. This offers a consistent schedule for facilities and couriers. 
CTSat: 10 am - 12 pm If specimens are received on weekends, they are placed in storage until they get logged in on Monday (marked as received on Monday). 
IA10 pm-12 am every day

The courier in Iowa has established routes throughout the state (same schedule as rest of week) to pick up specimens during the afternoon and deliver them between 10:00 pm to midnight so that the night shift can begin testing immediately so results are available by morning. Specimens from the Dakotas courier arrive at Iowa lab between 1-3 am the day after they are picked up (e.g., picked up at noon on Tuesday and arrive at the lab at 1 am Wednesday). Currently negotiating to expand pickups on weekends—would like specimens picked up in all ND and SD facilities 365 days a year and delivered that day to Iowa NBS lab.

MASat: 9-11 am 
MDSat: 7:30-am-2 pm 
MISat: 5-10:30 amAny specimens delivered after 10:30 am will not be processed until the following Monday. 
MNSat: 8 am-12 pm

Timeframe for specimen delivery allows MN to receive, accession, punch and run on Saturdays with time-critical results available for notification by the afternoon.

MOSat: 1-7 am           By contract, the courier must deliver samples by 7 am for screening to begin as soon as lab staff arrives. Sunday courier pickup samples from submitters, but not delivered until Monday. Implemented holiday courier in January 2014 for an additional $6k/year. 
MTSat: 7-9 amSpecimens are placed in an after-hour courier box on Friday evening and delivered to the lab on Saturday morning by the weekend technologist (given specimen delivery time of 7 am). Specimens are processed quickly on Saturday and then a portion of the sample is sent to the WI lab, via FedEx, for partial testing. Sending these specimens to the external lab on Saturday morning allows MT to have complete results on most disorders by Tuesday versus Wednesday.  
NESat: 9-10 am

Specimens are picked up at hospitals Monday through Saturday.  Specimens are delivered to the laboratory Monday through Saturday.

NCSat: 8:30 am-12:30 pm

Timeframe for specimen delivery chosen because only accessioning is currently done. Currently working to transition to Saturday testing.

NJSat: 9 am-12 pm

Specimens are transported to the laboratory by UPS, who provides Saturday delivery guaranteed by 12 pm. The process works very well except for holidays when guarantees are suspended and specimens could arrive later. We have worked with our local delivery center to permit NBS staff to pick-up packages on those affected days.

OHSat: 7-7:30 amCourier pickups specimens on Friday for Saturday delivery and on Sunday for Monday delivery.
PASat:9-10 amOn Sunday, there is no specimen receipt; testing activities only by PerkinElmer lab. Holiday schedules vary based on needs. 
SCSat: 7 am -2 pmState operated courier delivers specimens at 7 am. Specimens delivered by USPS is delivered between 9-9:30 am. Specimens dropped off by hospitals occurs between 7 am-2 pm. Currently, only process specimens received prior to 10 am. Any specimens delivered after 10 am are tested the next business day
TNSat & Sun: 7:30-9:00 am

Cutoff for accepting specimens is 9:45 am on Saturday. On Sunday, specimens are dropped off at the lab and held in a special container to give correct date of receipt, but not processed until Monday morning.

TXSat: 7:30-10:30 am

Closed on Federal holidays, but open on state holidays when there is specimen delivery. The newborn screening laboratory does not close more than two days in a row.

UTSat: 8 am-4:30 pm

Receive and accession specimens on Saturday and test on Sundays.  Testing is 6 days/week (Sunday-Friday). Don’t test on Saturdays and Federal holidays.

VASat: 7 am

Friday samples are delivered early Saturday morning so can be accessioned and delivered to the NBS lab as early as possible for punching. 

WISat: 6:30-10 amIf specimens are received after 10:30 am, they are processed the following day. 

 

Table 2: Result Reporting on Weekends and Holidays
StateWeekend/Holiday Result Reporting
AR

Remaining time critical results from Friday are reported on Saturday; results are called to the NBS program nurse on-call. Results from Saturday are called out Monday morning.  The on-call nurse has an agency cell phone and laptop that is turned on at the start of the lab work day (8:00 am). If there is any notice of critical or panic results, the on-call nurse she will proceed to contact necessary medical providers and parents as needed.

CA

Decentralized follow-up program with seven service areas that perform follow-up if there is a positive case or if a sample needs to be recollected. Follow-up receives notification from the lab and/or there will be a headline message in the computer system indicating a presumptive positive case.

CO

All results are reviewed by lab staff for time-critical disorders and critical results are communicated directly to the contracted medical specialist. On Sundays, data review is performed remotely. Staff member returns to the laboratory to make any critical calls.

CT

No call outs on weekends/holidays. If a presumptive positive result found on a Friday afternoon, the program will call the doctor to let them know of a potential case.

GA

No call outs on weekends/holidays, except if time-critical found on Friday afternoon.

IA

Results are communicated via web portal by a laboratory staff to on-call follow-up staff by 10 am on weekends/holidays. Time-critical conditions that require an immediate response are called into follow-up. IA provides weekend and holiday follow-up services to North and South Dakota on weekends and holidays.

KY

Lab staff call out critical results on Saturdays and holidays.

LA

Results are communicated by the lab to on-call follow-up staff.

MA

Lab staff communicate preliminary and final time-critical results to follow-up staff of the New England NBS Program (contractor for Maine, New Hampshire, Rhode Island and Vermont) who report urgent results on weekends. Note: Decision to screen for time-critical disorders only on weekends is based on available diagnostic centers available and clinical relevance.

MD

Results are communicated by the lab to on-call follow-up staff.

MI

Electronic notification and phone calls are made to follow-up staff in the afternoon. Everything is confirmed before follow-up reports out time-critical results to the medical centers. The follow-up coordinating centers also have on-call staff to handle the time-critical disorders that are reported out.

MN

Results are communicated by the lab to on-call genetic counselors, who forward hotline to cellphone each evening, weekend, and holiday. If biotinidase and IRT run on weekends, these results are not called out on Saturday. Note: Decision for disorder screening on weekends was made in conjunction with lab, follow-up and medical specialists; never go more than one day without testing.

MO

On Saturdays, the lab manager contacts on-call geneticists at one of the four contracted referral centers with a presumptive positive result for time-critical results requiring urgency. Each genetic tertiary center has staff on-call 24/7. The individual centers coordinate any on-call rotations, overtime, or holiday pay.

MS

PerkinElmer lab report results to on-call follow-up staff.

MT

Time critical results are reported by either the Montana follow-up coordinator or lab supervisor, depending on availability. Results are communicated by Tuesday.

NE

Perkin Elmer lab reporting times are Mon-Sun 24/7. Follow-up staff calls out time- critical disorders on weekends and holidays.

NC

On holidays, MS/MS sends abnormal results by encrypted e-mail and other disorders sent by fax; e-mail received by follow-up verifying receipt. Follow-up staff report time critical results on holidays only.

NH

Out-of-range results are called out by the UMass lab on Saturdays.

OH

Lab manager or lead scientists reports time-critical results on Saturday mornings to the physician.

PA

Genetic counselors are on call 24x7 to communicate results.

SC

Lab staff communicate abnormal results to follow-up staff on Saturdays and holidays. No lab reports are generated on Saturdays and holidays; therefore, phone calls and faxes are not covered or responded to by lab staff.

TN

Lab reports all disorders to follow-up staff on Saturday, who triage reporting using designated after hour mobile phone. Time critical and time-sensitive results are communicated to follow-up staff through email and followed by a phone call to ensure results were received. Follow-up follows recommendations from their genetic advisory committee as to what is considered to be an urgent call out versus if it can wait until Monday. If there is an abnormal result, the lab notifies follow-up and they contact the physicians that day with recommendations. They also notify the tertiary center depending on the disease and they will contact the provider and parents.

TX

The laboratory tries to test all specimens received and report preliminary urgent results for time-critical disorders before extended holidays. Follow-up staff has a limited protocol so only report the most urgent cases on weekends/holidays which limits the amount of staff needed.

UT

Normal results are automatically transmitted to the submitter by fax or secure email. Time-critical abnormal results are communicated by phone by on-call newborn screening follow-up personnel. On call follow-up personnel request recollection of any first samples that are unsatisfactory.

VA

One on-call nurse reports time-critical results on weekends/holidays.

VT

Out-of-range results are called out by the UMass lab on Saturdays. The Vermont NBS program is not technically open on weekend/holidays; however, sometimes conduct follow-up activities for special circumstances such as pending SCID result; asked to be conducted at home so can arrange follow-up directly.

WA

Call out time-critical results from Saturday to on-call follow-up nurse who reports time critical results on Sundays.

WI

There is a triangular structure-when the lab has the report they have an obligation to two sets of physicians. Sometimes they ask the PCP to call the specialist. The physician will not receive the written report until all testing is complete.

WY

Colorado lab staff communicate time-critical results on weekends/holidays to contracted physicians.

 

Table 3: Laboratory Staffing on Weekends and Holiday
StateNo. Lab Staff on Weekends/HolidaysWeekend/Holiday SchedulingCompensation
AR

2-3 lab technicians and no data entry.

No new staff was hired for Saturdays.

Saturday rotation for every other weekend (i.e. staff work 2 Saturdays/month).

Because the current staff was willing to accommodate the request to work on Saturday, they are allowed to work the hours that best fit their needs and are not assigned specific hours to work with the exception of the lab tech that works morning hours to receive specimens between 8 and 10 am.

Overtime
CO

Weekends: Two lab technicians and one half-day data entry staff. On Sunday, one lab staff reviews all results remotely. For urgent cases, staff member returns to the laboratory to make calls.

Holidays: Full staffed on holidays that occur around the weekend and/or serviced by courier; otherwise two lab technicians.

Rotation every fourth Saturday. 

Holidays considered normal work day; no rotation. Scheduled to work on holidays, unless staff requests time off. 

None; rotation part of the regular schedule.
IA

Weekend & Holidays: 2-4 night shift staff work from 9 pm-6:30 am every day of the week since all testing done at night.
Two-day shift staff work on Saturdays (8:00-4:30) and one on Sundays (8:00 am-12:00 pm).
Three and a half FTE cover data entry 365 days a year (3:00 am-11:30 am).

Note: Six new staff were hired for the night shift to support a 365 days per year, but not necessarily hired to specifically cover weekends or holidays.

Night shift has a nine-day work week with five days on and four days off with each starting on different days so their individual work schedules overlap with one another.


One day staff is regularly scheduled to work Tues-Sat (8:00 am-4:30 pm) and the other day staff rotates weekends/holiday; about every five weekends and 1-2 holidays/year.

One part-time data entry staff works Thurs-Mon (3:00 am-7:00 am) and one full-time data entry works Sat-Wed (3:00 am-11:30 am).

 

Night shift exempt from overtime, but receives a bonus payment of $4k/year.


Day shift is not salary, so do not qualify for overtime Staff receive flex day for weekend/holidays worked.


Data entry staff receive an hourly wage, holiday pay and receive full benefits.

KY

Hired three new staff (two scientists and one clerk) to work Tuesday-Saturday with vacated positions.

A scientist from another of the public health laboratories is trained in NBS works every other Saturday.

All staff rotate to work on holidays; schedule made six months in advance. 
LA

Weekends: Two lab technicians; no data entry.
Holidays: Four lab technicians and data entry staff on holidays with a courier. Note: Lab only opens on holidays that courier is delivering.

Saturday and holiday rotation.None; rotation part of regular schedule.
MA

Partial crew for both weekends and holidays plus data entry staff whose regular work week is six days/week.

Note: Hired new staff when transitioned to expanded operating hour week. Newly hired staff are most likely to work M-F when there are full staff and competency. Weekend staff less likely to include trainees.

Rotation 

None; rotation part of regular schedule.

MD

Weekend: Five laboratory Scientists and two data entry staff.
Holidays: Seven Laboratory Scientists and two data entry staff.

Rotation once every fourth Saturday and two teams rotate every other holiday (except when closed for Federal holidays); 6-8 hour shifts.

Laboratory staff earn compensatory time when they work weekends and holidays. Data entry staff earn overtime.

MIFive lab staff, plus data entry.Rotation

Overtime for holidays and time-balance for Saturdays worked within a two week period. If staff not given a two-week notice to work Saturday, then receive overtime pay.

MN

2-3 depending on expected workload. One employee is from PerkinElmer genetics that performs MS/MS screening and the other employee(s) is from state newborn screening lab.

No data entry.

Rotate Saturdays once every two months (i.e. each lab staff work six Saturdays/year). Also on holiday rotation (1-2 holidays/year).

No overtime, but are allowed to time-balance Saturdays worked within the same pay period. Lab staff receives an additional eight hours of vacation time when working on holidays.

Note: Classification for all staff changed to environmental analyst II to avoid overtime costs (i.e. get paid straight time with new clasification) 

MONine lab staff, including one manager and two scientists. Other six staff, including data entry, is pulled from a pool of part-time adjunct employees.Hired three lab staff to work Tues-Sat shift and one position works holidays. Remaining Saturday coverage is voluntary part-time staff.

No overtime, but receive straight time pay under classification as a secondary assignment; pay is added to the regular paycheck.

MTOne lab staff, with supervisor and/or follow-up coordinator available as needed. Data entry varies depending on if newborn screening tech has the weekend duty.Technicians rotate weekends and holidays; not always NBS staff.

No overtime

NETypically between 12-15 lab staff, including data entry.Some rotate (typically once a month) while others have a permanent schedule that includes weekends. No overtime
NC

Holidays: Five laboratory technicians, one central accessioning, one mailroom and one data entry staff.

Weekend and holiday schedule is based on volunteer sign-up.

Overtime for holidays only

NJ

Weekend: Four lab supervisors and/or technicians.

Holidays: Seven lab technicians plus two data entry for weekday holidays only.

Rotate every weekend and holiday.

Lab technicians get overtime pay; lab supervisors do not qualify for overtime.

OHWeekend: One manager, five lab technicians, and one data entry.
Holidays: One manager, six lab technicians, one data entry and one follow-up.

Designated Tues-Sat shift. All staff rotates for working holidays (about 2-4 times for each staff per year).

Not funded separately or differently for weekend staff. Positions added when needed, usually when new disorders are added to the panel. New hires start on Tues-Sat schedule.

Choice of overtime or compensatory time earned for holidays, but not for Saturdays.

PA12-15 staff members. Holidays are workload dependent.Rotation and Tuesday thru Saturday shifts.

Part of regular shift; overtime as needed.

SC

3-4 lab technicians, plus one half-day data entry staff on Saturdays and holidays.

Note: Hired two additional lab staff to accommodate Saturday testing. If expand to seven days/week, will need to consider different work schedule to ease Saturday rotation frequency.

Lab staff rotates approximately every 3rd Saturday. Staff also rotate holidays, working 3-4 times /year.

None for lab staff. Data entry staff receive compensatory time for half-day worked on weekend/holiday.

TNFour lab staff; no data entry staff.Lab staff rotates once a month.

Receive one day off the following week for Saturdays worked. Any time worked over 37.5 hours/week, staff receive compensatory time (hour for hour).

TX

22 staff for testing, 5-6 staff for specimen accession, and 3-4 part-time staff for data entry.

Note: Hired five new staff to accommodate weekend operations, who rotate Saturdays with existing staff.

Lab staff rotates approximately every 2-3 Saturdays. Full staff work on state holidays and lab closes on federal holidays.

Lab staff receive flex day to be used same week as Saturday shift so still work 40 hours/week.

UT

Two staff in sample receiving and one lab supervisor to sign out results on Saturdays; 1-2 lab technicians for specimen testing on Sunday and one on-call supervisor.

Note: Utah reallocated funds and eliminated one FTE to expand to Saturday operations.

One lab tech has set schedule for Sun-Thurs; second lab technician rotates.
Sample receiving staff rotate working two Saturdays/month.
None
VA

Two lab techs on Saturdays and will eventually grow to five plus eight data entry when expanding Saturday screening in 2018.

For holidays, there are 15-20 in the lab and 8 in data entry since screen all disorders.

Note: Hired one contract staff to work weekends only to help with sample prep/punching.

Weekend and holiday rotation (2-3 holidays/year). The lab is planning to recruit four scientists and one senior scientist to regularly work a shift that includes Saturday.

New staff will be hired as primary coverage for Saturday work. However, to maximize existing laboratory staff will require additional cross-training and up-to-date competency assessments on various benches for all time-critical disorders. This will allow staff to provide broader coverage and reduce the number of weekends worked.

Weekday staff will be on rotation only to provide coverage for Saturday personnel.

Saturday staff will receive 10% differential pay over their base pay to compensate for Saturday work. Weekday staff who cover for Saturday personnel can choose between overtime pay or accrue compensatory time.

WAThree lab staff on Saturdays and one on Sundays to read/report results.

Two hires to work Tues-Sat shift; one rotation. Lead worker rotates for Sunday shift (once a month).

Holidays are volunteer sign-up.

Overtime for holidays only; weekends receive flex day within a pay period.

One lead and one technician on-call in case regularly scheduled Saturday staff is ill. Receive a $25 flat fee for being on-call and exchange-time if actually come-in on Saturdays.

WIThree lab staff, including data entry.Rotate once a month.None

 

Table 4: Follow-up Staffing on Weekends and Holidays
StateWeekend/Holiday Follow-up StaffingCompensation
AROn-call Saturday rotation starting at 8 am. Follow-up staff works about 10 Saturdays and one holiday per year.

Follow-up staff provided with compensatory time for hours worked on weekends and holidays.

CADecentralized follow-up program that has seven service areas that perform follow-up if there is a positive case or if a sample needs to be recollected. One on-call staff checks to see if there are any urgent cases on Saturday and Sunday; required to check-in twice a day (morning and afternoon). 
IAOn-call rotation working 8 am-3pm on Saturdays and 8 -10 am on Sundays. Note: Provide weekend and holiday follow-up services to North and South Dakota on weekends and holidays.

No overtime because have set hours.

LAOn-call monthly rotation for weekends and holidays (work holidays that fall within their month). During lab operating hours, two staff on-call for CAH and one on-call for time-critical disorders.

Follow-up staff provided with compensatory time for hours worked on weekends and holidays.

MAOn-call monthly rotation.

Follow-up staff provided with compensatory time for hours worked on weekends and holidays.

MDOn-call rotation every three weekends and rotate every major holiday (non-major holidays are generally grouped with corresponding weekend).

Follow-up staff provided with compensatory time for hours worked on weekends and holidays.

MIRotate shifts every other weekend/holiday; not on-call.

Overtime for holidays, but not on weekends. Receive compensatory day for Saturdays worked.

MN

Four program genetic counselors rotate on-call shift one week at a time (i.e. each on call one week/month). This on-call shift covers evenings, weekends and holidays.

Genetic counselors can remotely access LIMS, network drives and complete electronic faxing from a virtual private network.

Per union contract, genetic counselors receive flat rate of $200/week for on-call status plus an additional amount for calls taken, reports reported, etc.

MSFollow-up nurses are on-call on Saturdays, Sundays and holidays. Two nurses rotate on-call status seven days on and seven days off (i.e. work two weekends/month). Holidays are included in the weekly rotation.

Follow-up nurses receive on-call pay on weekends/holidays—one rate for standby hours if no call is received and another rate for call back hours if calls are received.

MTLab supervisor or follow-up coordinator are not officially on-call, but are available by cell phone in case of an urgent result; split weekend/holiday availability. 
NERotate on-call shifts, which are 5:30 pm-7:00 am 365 days/year. Program manager takes first weekend/week each month (12 shifts/year) and two follow-up staff alternate the remaining weeks (20 weeks/year). If follow-up staff is ill, then program manager takes the shift.

The two follow-up staff receive on-call rate, which is 8% of usual hourly pay for standby and time and a half for responses/activity. Program manager does not receive on-call pay.

NCOn-call on holidays that the lab is open and reporting abnormal results.

Follow-up staff can flex time is scheduled to work on holidays.

NJRotate on-call shifts; in the event of a possible presumptive result, follow-up remains on call until the final result is available that day.

No over time; no flex day for on-call

OHNo follow-up staff on weekends; rotation for holidays.

Choice of overtime or compensatory time earned for holidays worked.

SCRotate every third Saturday and holiday that the NBS staff work; not on-call.

Compensatory day

TNOn-call rotation from 7:00 am-3:30 pm.None
TXThree follow-up nurses’ on-call (one metabolic, one non-metabolic and one backup nurse); rotation once every six weeks.

A compensatory day that is accrued into vacation time.

UTOn-call rotation for Saturday and Sunday; work 1-2 weekends/month.

Compensatory day

VAOn-call rotation for one weekend/month and rotate holidays as needed.

Currently, offer overtime as compensation. When lab transitions to expanded Saturday testing in 2018, nurses will work altered work schedule for Saturdays worked to minimize the need for overtime.

WAOn-call rotation; usually work from home unless urgent positive.

Receive $25 flat fee to be on-call and receive over-time if called into the office.

 

Table 5: Technical Support During Non-Traditional Work Hours
StateAvailability of Technical Support
AR

Agency IT Staff available by phone/email.

No vendor support.

IA

Agency IT support is on-call on weekends and holidays.

No vendor support on weekends and holidays.

MA

Agency IT staff is on-call.

Vendor contract depends on instrument and maintenance contract.

MD

Agency IT staff on-call.

No vendor support.

MI

Agency IT is on-call.

Vendor support is spotty, no firm contract.

MN

Agency IT staff and vendor support available for emergency assistance.

MO

Agency IT help desk is available for network support.

No vendor support.

MT

Agency IT staff available on-call for emergencies only.

NE

Certain vendor support is available. Equipment redundancy allows for some downtime. 

NC

Agency IT staff available by phone.

No vendor support.

NJ

On-call agency IT and vendor support; and have access to remote technology to read results.

OH

Agency IT staff for emergencies only.

The vendor provides limited phone support.

PAOn-call
SC

No agency IT support or other vendor support. 

Note: Currently working to get after-hour IT support. For vendors, can email tech support, but usually, don’t receive a response until next business day.

TN

Agency IT staff on-call for support.

No vendor support.

TX

Agency IT staff provides on-call support.

The vendor provides hotline support from 7 am – 5 pm; onsite support if necessary for LIMs only.

UT

None. Limited IT support on weekends has created problems if LIS issues occur. IT issues can be remedied through NBS health informaticist (on-call).

VA

 

Agency resources for application support and state IT agency for network support.

No vendor support.

IT and vendor support will be needed when the transition to full testing on Saturdays occurs; discussions in process now. 

WA

24/7 on-call IT support

WI

Agency IT staff available for emergency situations.

No vendor support.

 

Checkout Missouri's Volunteer Staffing Model for converting to a six day laboratory work week which was presented at the 2017 APHL Newborn Screening and Genetic Testing Symposium.

Resources in Section 6: Overview of NBS Weekend & Holiday Operations