Before your state decides to expand its services to holidays and weekends, review the lists below to determine logistics, staffing, specimen delivery, costs, and approval process considerations. NBS staff should use this checklist to make sure that all bases are covered before moving forward with implementing expanded operations with the NBS lab, follow-up, and courier. However, given the variation in newborn screening (NBS) programmatic and state legislative processes, not all items will need to be completed by each state, but instead, this is a list of considerations to help your program anticipate challenges and prepare for the expansion of services and operating hours.
Checkout the 2012 Laboratory Efficiency Initiative, A Practical Guide to Assessing and Planning Implementation of Public Health Laboratory Service Changes.
Weekend & Holiday Program Logistics
- Work with the state Health Commissioner, follow-up staff, specialists, and the newborn screening advisory committee to determine which disorders to test and report out on weekends/holidays. Develop a protocol for your weekend/holiday notification strategy.
- Identify and procure equipment for efficient weekend/holiday screening (i.e. does your lab have appropriate backup instrumentation in the event of a failure during weekend/holiday if there is no vendor support?)
- Assess need for data entry staff on weekend/holidays.
- Assess need for contracting referral lab on weekends/holidays and which assays will be tested (i.e. all, molecular only, MS/MS, etc.). Procure any necessary contracts, including courier contract to get specimens from state NBS lab to referral lab on weekends/holidays.
- If testing is done in-house, develop an adjusted laboratory workflow to accommodate weekend/holiday screening.
- Procure vendor contracts for weekend/holiday Laboratory Information Management System (LIMS) and instrument support.
- Procure agency Information Technology (IT) support for weekends/holidays (i.e. on-call support).
- Ensure lab staff has remote access to instruments and LIMS in order to evaluate results and communicate out-of-range values to follow-up staff.
- Ensure follow-up staff has access to remote technology to receive and report out results to medical providers.
Weekend & Holiday Staffing
- Be aware of your state’s union or civil service rules for changing work schedules to include weekends/holidays and determine appropriate compensation (i.e. job classification changes, overtime, on-call fee, flex or comp day, part of the regular salary, etc.).
- Identify a staff “champion” to help gain buy-in from other staff for weekend/holiday operations.
- Incorporate expectations for weekend/holiday shifts for incoming staff via job descriptions, interview process, etc.
- Ensure adequate staffing, including correct expertise/management for weekend/holiday shifts and develop staffing plan (i.e. hire new part-time or full-time staff, recruit staff from other sections of the public health lab to take weekend/holiday shift, etc.).
- Develop staff scheduling system for weekend/holiday shifts (rotation, volunteer sign-up, etc.).
- Cross-train laboratory staff on different equipment/benches.
- If follow-up does not operate on weekends and/or holidays, cross-train laboratory staff on necessary follow-up protocols for calling out urgent results on weekends/holidays to specialists and/or genetic centers.
Specimen Delivery on Weekends & Holidays
- Negotiate contract with the courier for specimen pickup and delivery to the laboratory on weekend/holidays.
- Identify other means to receive specimens on weekends/holidays, such as drop-off location at local/county health department, shared courier, etc.
- Ensure that the courier is aware of different pickup locations at the birthing facilities and/or drop-off location at the lab if different than rest of regular work week.
- Inform birthing facilities about weekend/holiday pickup and times; consider performing workflow analysis for hospitals.
- Provide education about the importance of newborn screening to the courier provider, as needed.
- Pilot test weekend/holiday courier route with large birthing facilities and then expand to additional facilities.
To help hold your courier service accountable it is important to build in a formal monitoring process as part of the courier contract and include specific language on pick-up and delivery times and necessary recourse for any contract violations. The bidding process should also state-specific requirements, such as the delivery cutoff times by day. It is important that NBS program staff are involved in the contract writing process to ensure that delivery needs are adequately specified. See Michigan’s Notice of Contract with STAT Courier which can be used as an example to help your program create a comprehensive courier contract that will meet your state’s needs.
Approval for Funding
- Estimate the cost of expanding program/delivery services on weekends/holidays, including but not limited to:
- Compensation for NBS laboratory staff to cover weekend and/or holidays (overtime pay, flex days, other).
- Compensation for NBS follow-up staff to cover weekend and/or holidays (on-call, flex days, other).
- Vendor support for weekends/holidays.
- Agency IT support for weekend/holidays.
- Courier or other specimen delivery service for weekend/holidays.
- Additional assays and other lab materials.
- Develop a budget or fiscal note to support the expansion of NBS program operating hours, including laboratory and follow-up staffing, laboratory testing, information technology, etc. This may be done in conjunction with adding new disorders to the panel.
- Obtain approval by NBS Advisory Committee, or other authority, for the increase in funding, as needed.
- Obtain approval by the State Budget Authority, as needed.
Authority for Expanded Newborn Screening Program Operating Hours
- Obtain approval from the NBS Advisory Committee, as needed.
- Obtain approval from the Board of Health, Health Commissioner, Title V Coordinator, etc., as needed.
- Obtain regulatory rule changes to increase NBS fee, if necessary.
- Obtain mandate/approval to start screening on weekends/holidays, if necessary.