Survey Overview

The survey is being used by CHILDx as a research tool to determine how pediatric testing is performed, what are the most important criteria for working with reference labs, and what priorities various factors have related to sending out pediatric testing. In addition, the survey will be used to identify which pediatric tests are most commonly ordered to help prioritize the research of pediatric-specific reference ranges. It is the hope of the committee that the research findings will be published.

Surveys were sent to U.S. physicians affiliated with the Society of Pediatric Pathology and/or working at hospitals with higher than average pediatric census. Over 430 physicians and laboratory directors were surveyed.

 

Research Objective

The primary purpose of this survey is to identify the unique needs of hospitals serving pediatric patients. Specific information to be determined by the survey includes:

What are the unique challenges when sending pediatric samples to reference laboratories?

What criteria do hospitals use when determining where to refer pediatric samples?

What are the technical issues related to pediatric sample referrals?

What importance do hospitals place on specific pediatric reference ranges?

What pediatric tests are commonly sent out?

Results of the survey will help the CHILDx Members and Board determine the future direction of the organization as it relates to the CHILDx mission, vision, goals, and priorities.

 

Survey Summary

Sendout Volume

The majority (61.5 percent) of hospitals surveyed stated that only between 1 and 5 percent of pediatric laboratory volume is sent to reference laboratories. Another 12.8 percent send out between 5 and 10 percent of volume.

Test Mix

The following is a summary of the top 13 sendouts identified by surveyed hospitals:

• Chromosome Studies
• Organic Acids
• Amino Acids
• Lead Level
• Newborn Screens, for 6 months=173
• IGFI
• 17 OH Progesterone
• Free Thyroxine, for 6 months=180
• Growth Hormone
• H. pylori IgG
• Hep C
• HIV Ab
• Insulin Total

Statistics on Sendouts Decisions

Ordering physicians and pathologists control most (41.3 percent) of sendout decisions. Cost and contractual obligations control where another 23 percent of sendouts are sent.

The biggest issue that respondent hospitals face regarding pediatric sendouts is minimum sample volume requirements (mentioned 25 times out of 39 responses). However, when determining which reference laboratory to use when sending out samples, these requirements ranked third most important, behind service and turnaround time. Cost was also mentioned as a major factor in deciding where hospitals choose to refer samples. Turnaround time was also mentioned (13 of 39 responses) as a primary challenge with regard to sending out pediatric samples.

The majority of hospitals surveyed (77.5 percent) send samples to more than one reference lab. In addition, 40 percent of hospitals reported sending samples to more than five laboratories, and seven of 40 (17.5 percent) send to more than 50 different laboratories. The major reason for using multiple labs is test availability (21 of 33 responses). The second most common reason for sending samples to multiple labs is ordering physician preferences (11 of 33 responses). Cost (13.0 percent) and turnaround time (11.1 percent) are also major reasons for using multiple reference laboratories. Only 20.0 percent of respondent hospitals reported using only one reference laboratory.

Of the hospitals surveyed, 56.1 percent are part of a local or regional health care or laboratory system. The majority (66.7 percent) perform some testing within their own system. Only one hospital stated it performs all testing within its system, and 29.6 percent stated they perform no testing within its own system.

Quest/Nichols/AML (29.3 percent), ARUP Laboratories (29.3 percent), and Mayo Medical Laboratories (22.0 percent) were most commonly listed as the national reference laboratories used for primary reference sendouts. Of the hospitals that use a primary reference laboratory, an average of about 60 percent of sendout volume was sent to the primary reference laboratory. Hospitals ranked quality of service, a large array of pediatric reference ranges, turnaround time, and breadth of test menu as the areas of greatest strength among the reference labs they used. Areas identified for improvement include turnaround time (14.3 percent of responses), reference ranges, price, and one-stop shopping (each 10.7 percent of responses).