Durant Thomas J S, Peaper David R, Ferguson David, Schulz Wade L
Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT.
Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT.
J Appl Lab Med. 2020 Nov 1;5(6):1194-1205. doi: 10.1093/jalm/jfaa121.
Coronavirus disease 2019 (COVID-19) was formally characterized as a pandemic on March 11, 2020. Since that time, the COVID-19 pandemic has led to unprecedented demand for healthcare resources. The purpose of this study was to identify changes in laboratory test utilization in the setting of increasing local incidence of COVID-19.
We performed a retrospective assessment of laboratory test order and specimen container utilization at a single, urban tertiary care medical center. Data were extracted from the laboratory information system database over a 10-week period, spanning the primordial inflection of COVID-19 incidence in our region. Total testing volumes were calculated during the first 2 and last 2 weeks of the observation period and used as reference points to examine the absolute and relative differences in test order volume between the prepandemic and COVID-19 surge periods.
Between February 2, 2020, and April 11, 2020, there were 873 397 tests ordered and final verified. The in-house SARS-CoV-2 PCR positivity rate for admitted patients in the last week of the observation period was 30.8%. Significant increases in workload were observed in the send-out laboratory section and for COVID-19 diagnosis (PCR) and management-related testing. Otherwise, there was a net decrease in overall demand across nearly all laboratory sections. Increases in testing were noted for tests related to COVID-19 management. Viral transport media and citrated blue top containers demonstrated increases in utilization.
Increasing local incidence of COVID-19 had a profound impact on laboratory operations. While volume increases were seen for laboratory tests related to COVID-19 diagnostics and management, including some with limited evidence to support their use, overall testing volumes decreased substantially. During events such as COVID-19, monitoring of such patterns can help inform laboratory management, staffing, and test stewardship recommendations for managing resource and supply availability.
2019年冠状病毒病（COVID-19）于2020年3月11日被正式列为大流行病。自那时以来，COVID-19大流行导致对医疗资源的需求达到前所未有的程度。本研究的目的是确定在当地COVID-19发病率上升的情况下实验室检测利用情况的变化。
我们对一家城市三级医疗中心的实验室检测订单和标本容器使用情况进行了回顾性评估。数据从实验室信息系统数据库中提取，为期10周，涵盖了我们地区COVID-19发病率的初始拐点。在观察期的前2周和最后2周计算总检测量，并将其用作参考点，以检查大流行前和COVID-19激增期之间检测订单量的绝对和相对差异。
在2020年2月2日至2020年4月11日期间，共下达并最终核实了873397项检测。观察期最后一周入院患者的院内严重急性呼吸综合征冠状病毒2（SARS-CoV-2）聚合酶链反应（PCR）阳性率为30.8%。在外部实验室部门以及COVID-19诊断（PCR）和管理相关检测方面，工作量显著增加。否则，几乎所有实验室部门的总体需求都出现了净下降。与COVID-19管理相关的检测量有所增加。病毒运输培养基和枸橼酸钠蓝顶容器的使用量有所增加。
当地COVID-19发病率的上升对实验室运作产生了深远影响。虽然与COVID-19诊断和管理相关的实验室检测量有所增加，包括一些使用证据有限的检测，但总体检测量大幅下降。在COVID-19等事件期间，监测此类模式有助于为实验室管理、人员配备以及管理资源和供应可用性的检测管理建议提供信息。
