Reinventing diagnostic services in the face of growing demand

Improving diagnostic testing to identify diseases earlier and more efficiently is crucial to saving lives, cutting backlogs, and reducing some of the financial burden on healthcare services. This article will examine strains on the diagnostic sector as well as innovations in products and services that can improve the coping capacity of diagnostic services.

Shortage of healthcare workers

In the US, the number of active pathologists fell by 17.5% between 2007 and 2017. Since then, the situation appears to have worsened, with 56% of pathology departments looking to hire additional staff, up from 45% in 2017. The shortage of pathologists is leading to longer wait times for results – in some cases, this may be over sixty days. Meanwhile, thirty-five percent of pathologists are said to be suffering from ‘burnout’ due to the increased workload.

The phlebotomy sector is experiencing similar issues. Due to advancements in technology, more conditions can be diagnosed through blood tests; combined with an ageing population, this is leading to surging demand for phlebotomy services. However, the level of training required for phlebotomists is making it difficult for departments to fill vacancies as they attempt to cope with rises in demand. Over the decade, it is expected there will be around 21,500 openings for phlebotomists each year on average.

Demand for diagnostic products

Alongside the increasing need for testing, there is an ever-growing demand for diagnostic products. For instance, it is estimated that the North American molecular diagnostic market will grow by 6.6 percent between 2019-2024. The COVID-19 pandemic accelerated growth, as demand for molecular testing increased twenty-fold between March and October 2020.

However, this demand has created a severe shortage of laboratory supplies including vital collection tubes, syringes and collection needles, meaning staff have been instructed to only carry out urgent blood work, to save supplies. In January 2022, the FDA expanded its medical device shortage list to include all blood specimen collection tubes due to supply and demand challenges caused by the pandemic.

Protecting healthcare professionals

In this pressurised environment, it is crucial that diagnostics staff are provided with appropriate equipment that is easy to use and minimises the risk of injury. For instance, phlebotomists experience on average one accidental percutaneous blood exposure every year. Devices for blood collection should be designed to be as easy to use as possible, especially as some phlebotomists may come to the profession after short, intensive training programmes. However, even as manufacturers look to develop more intuitive products, additional training and support may be required to ensure correct use of blood collection products and other diagnostic devices.

Coping with demand

Diagnostic services are adapting to address some of the issues outlined above. Many healthcare providers in the US, Canada and other countries across the world have signed up to the Choosing Wisely campaign, an initiative seeking to advance national dialogue on avoiding unnecessary medical tests, treatments, and procedures. The goal is to reduce avoidable use of healthcare services and ensure diagnostic products are reserved for those most in need.

One study assessed the impact of issuing an alert to doctors as they are about to place an order for medical tests and found that it led to a 29% reduction in orders for one common test. The ‘best practices alert’ encouraged doctors to reconsider tests which may be ordered after a patient has already been admitted and therefore would not impact care, or repeated testing where one test may be sufficient.

The way that services are delivered is also evolving. One solution gaining traction is the consolidation of imaging and laboratory services into one stop shops. This would allow companies to offer cardiac, endoscopy and screening services all in one place. Another emerging concept is the ‘medical village’ or ‘polyclinic’ where a range of specialists, nurses, diagnosticians and even dentists are all based in one convenient location, sometimes even based in shopping malls or community centres. With all these specialists available, wait times can be dramatically decreased with patients sometimes referred to relevant practitioners on the same day.

In future, we are also likely to see more innovation in Point of Care (POC) diagnostics. The volume of POC testing rose dramatically due to the COVID-19 pandemic, and the urgent need for faster on-site screening. The ability to obtain diagnostic results close to the patient ensures faster results and implementation of therapy. Wider implementation of POC solutions could be game-changing in multiple disease areas.

Digital pathology

Innovations within healthcare delivery are likely to include more automation. Activities such as online booking and specialist testing are already being managed by machines. In future, digital pathology could help overstretched laboratories make vast leaps in efficiency. Digital pathology refers to technology allowing cellular pathology laboratories to share their work digitally, instead of sharing a microscope and glass slides. It allows pathologists to work remotely – a bonus especially during the pandemic– making it easier to get a second opinion on a sample while also offering learning opportunities for trainee pathologists.
Though still in its formative stages, those who have adopted digital pathology have seen positive results. One department that has been using digital pathology since 2016 saw 21% more cases signed out by pathologists per year on average since full implementation. Not only does digitalisation speed up this diagnostic process, but pathologists also regain valuable time for other critical tasks that need more attention.

Conclusion

To cope with the burden of demand, the diagnostic industry must adapt products and services for strengthened efficiency. Simultaneously, the medical device sector should continue to prioritise human factors in product development, so that healthcare professionals can conduct testing as effectively and safely as possible. The stakes are high, with a recent study showing diagnostic products were used in 88% of patients’ initial diagnosis, 77% of treatment monitoring and 72% of follow-up. A collaborative approach from medical device producers and healthcare providers could help to ensure devices are used optimally, and that professionals are given appropriate support.