Plan sets 24 hours as infant tests goal

Quicker delivery to lab state’s aim

The Arkansas Department of Health plans to propose requiring hospitals to submit blood samples collected from newborns to the department’s laboratory within 24 hours, instead of within 48 hours, as state regulations now require.

Patricia Scott, manager of the Health Department’s newborn screening program, said the change is part of an effort to speed up the sample delivery times.

The department’s goal is for blood samples to arrive at the state laboratory within 48 hours of when the samples are collected. In the fiscal year that ended June 30, however, only 13 percent of the 36,000 samples collected from newborns were delivered within that time frame.

Hospitals “want to do the right thing, I’m sure,” Scott said. “It’s just going to take all hands on deck.”

The testing is done by pricking the heel of a baby and collecting drops of blood on a piece of filter paper.

The paper is then sent to the Health Department’s laboratory in Little Rock, where the blood is tested for 28 disorders.

In some cases, early diagnosis of a disorder can allow treatment to start in time to save a baby’s life or prevent permanent health damage.

But the Milwaukee Journal Sentinel reported in November that thousands of samples collected nationwide each year arrive at laboratories five or more days after they are collected - two days longer than the delivery time recommended in a report by the American College of Medical Genetics.

Arkansas Board of Health regulations currently say blood samples should be collected from newborns 24-72 hours after birth and submitted to the laboratory within 48 hours of collection.

A sample is considered “submitted” if it’s in the mail within 48 hours, even if it doesn’t arrive at the laboratory until a day or two later.

The proposed change would get the regulation more in line with the department’s goal, which is for the samples to arrive at the Little Rock laboratory within 48 hours of collection.

The change would require hospitals to submit the sample within 24 hours of collection, either by delivering it to a county health unit or by using a same-day courier service or overnight delivery.

It would effectively prohibit “batching,” or collecting multiple days worth of samples to be shipped to the Health Department all at the same time.

The department already discourages hospitals from batching, but the Board of Health regulations don’t prohibit it and some hospitals continue the practice, Health Department spokesman Ed Barham has said.

A Health Department courier delivers samples daily, Monday through Friday, from the county health units to the laboratory in Little Rock. More than half of the hospitals in the state that deliver babies use the courier, Scott said. Others use FedEx, UPS, the U.S. Postal Service or a private courier.

The laboratory is not open on weekends or holidays, and the Health Department courier does not operate on those days.

Health Department spokesman Cathy Flanagin said hospitals would be required to use overnight-delivery services when the Health Department courier is not operating and the laboratory is closed. That would ensure that the samples arrive at the laboratory on the morning of the first day the laboratory reopens, she said.

She said department officials have discussed extending the laboratory’s hours, but don’t currently have any plans to do so.

“In most cases, the problem hasn’t really been with us,” Flanagin said. “It’s been with getting [the samples] from the hospitals.

“That’s why [extending the laboratory hours is] not as big a priority as working with the hospitals to try to decrease the time it takes them to get us the samples, because that’s where the delay has been.”

Scott said the department plans to present the proposal to the Board of Health in April, along with updates to reflect the passage of two laws last year.

Those laws, Acts 428 and 768, allow the board to expand Arkansas’ screening program to include additional genetic disorders and require hospitals to perform tests designed to detect congenital heart defects.

Health Department officials have been talking about changing the sample delivery requirements “forever,” and the new laws “just gave us a good time to do it,” Scott said.

Paul Cunningham, executive vice president of the Arkansas Hospital Association, said Friday that he had not studied the proposal and wasn’t ready to comment about it.

Mark Lowman, a spokesman for Baptist Health System, said the system supports the proposal.

The system uses a private courier to deliver samples five days a week from its hospitals in Little Rock and North Little Rock to the Health Department laboratory and from the system’s hospitals in Stuttgart and Arkadelphia to county health units. The system’s Heber Springs hospital does not deliver babies.

“We’re structured to be able to deliver within the time frames described,” Lowman said. He added, “We’re supportive of doing anything that enhances clinical outcomes and the health of our newborns.”

Jennifer Hunt, chief of pathology services at UAMS Medical Center in Little Rock, agreed that the proposal sounds like a good change.

“Some of the tests do have ramifications in the first week or two of life, so you do want to get those results back into the proper hands for clinical management as soon as possible,” Hunt said. “You want to minimize any potential delay that you have control over.”

The Health Department courier picks up samples from UAMS Monday through Friday.

Representatives of St. Vincent Infirmary Medical Center in Little Rock and St. Bernards Medical Center in Jonesboro each said last fall that their samples are delivered to the Health Department daily, Monday through Friday, either by hospital personnel or the Health Department courier.

Northwest Health System sends the samples daily to the laboratory through FedEx overnight Monday through Friday from its hospital in Bentonville, and through FedEx or the Health Department courier Monday through Saturday from its women’s hospital in Johnson, a health system spokesman has said. The system’s Springdale hospital does not deliver babies.

A spokesman for Washington Regional Medical Center in Fayetteville said in November that the hospital delivers samples to the nearby county health unit only on Mondays, Wednesdays and Fridays. Hospital spokesman Terry Fox didn’t return a phone message Friday seeking comment.

The Milwaukee Journal Sentinel story reported that a sample drawn from a baby at Arkansas Methodist Hospital in Paragould was not tested atthe Health Department laboratory until 3½ weeks after the baby was born in 2011.

As a result of the test, the baby, Aiden Cooper, was diagnosed with galactosemia, a disorder that prevented his body from digesting galactose, a sugar in breast milk and traditional formula.

By the time the boy’s mother learned of the diagnosis, he had already spent two weeks at Arkansas Children’s Hospital in Little Rock, where he was rushed by ambulance after developing a rash and swollen stomach, the Journal Sentinel reported.

In letters sent to hospital administrators last week, Health Department Director Nathaniel Smith said Aiden’s sample arrived at the Health Department laboratory six days after it was collected. According to the Journal Sentinel story, it was 18 days after that when the sample was tested at the Health Department laboratory.

The letters asked hospitals to use the Health Department courier service or a same-day private courier and use overnight delivery ahead of holiday weekends.

“For maximum impact and effectiveness, newborn screening specimens should be collected 24-72 hours after birth and submitted promptly to the [laboratory], ideally on the same day collected,” Smith wrote.

The letters included charts showing each hospital’s performance over the past four years in delivering samples to the laboratory within 48 hours and how it ranks in delivery times compared with other hospitals.

The department had initially planned to send the letters last month, but the mailing was delayed so that more data could be included, Scott said.

According to the letters, the department plans to send hospitals quarterly updates with information on their delivery times.

Front Section, Pages 1 on 01/19/2014

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