Since laboratory space is at a premium, it’s tempting to outsource specimen storage. Endocrine News weighs the pros and cons of moving specimen storage offsite or keeping it at arm’s length.
Changing healthcare policies have led to new realities at medical labs. Reimbursements and test volume are down, making efficiency and smart budget management more essential than ever. Some laboratories are turning to outside storage facilities to reduce the costs associated with keeping specimens in-house. But what are the tradeoffs?
According to a recent report by Wendy M. Banker, MPA, titled “Could Specimen Storage Outsourcing Help Labs Compete in Today’s Cost Conscious Environment?,” a strong argument exists for using external storage facilities. Space is among a lab’s most valuable commodities — fewer specimen blocks means more room for equipment and experiments. However, lab professionals fear losing the accessibility that in-house storage offers.
This fear, and other preconceptions about the risks of offsite storage, has perpetuated hesitation on the part of laboratory managers and directors. But processes and technology for storing specimens have improved, and renting outside space is looking more and more appealing from an economic perspective.
There is no “one size fits all” solution, so laboratory professionals must weigh storage options based on the particular circumstances of their facility. The following factors are a summary of the variables to consider when deciding where to house slides and specimen blocks.
“Lab storage practices vary greatly across organizations, however in-house is the dominant approach used today,” Banker explains in the report. She describes the storage practices of most organizations as “fragmented” — meaning spread throughout a number of spaces around the facility. Specimens tend to be organized by age so that the newest samples are the closest and oldest are tucked further away.
By keeping storage onsite, researchers enjoy the convenience and quick turnaround of pulling specimens. A staff member can be sent to track down the item and it can be returned to the requestor in as little as minutes. But this assumes a meticulously organized and maintained storage system with adequate staffing to keep things running smoothly. It is not unusual for specimens to end up misplaced when lab workers lack training or rely on a flawed organizational system.
Some lab managers and directors also question whether or not tracking down specimens is the best use of staff time. Every hour a staff member spends searching for a lost specimen is an hour that they are not contributing towards tests and other daily operations. Allocation of valuable resources is a key consideration in the decision to store onsite or offsite. Human resources are precious, as is space, and the opportunity cost of devoting these to storage grows with the size and age of the lab.
For smaller and newer labs with fewer specimens, offsite storage may not be necessary. Larger labs and those with older blocks taking up room, however, may want to seriously consider their options.
Lab managers and directors cite the safety and security of specimens as two additional reasons to keep storage within their facility. This gives them more control over the environment that blocks and slides are kept within, while moving offsite requires a leap of faith that an outside company will properly protect and care for their specimens.
No matter where a lab stores its blocks and slides, legal liability comes into play when specimen damage occurs. Banker’s report states that, “Although seen as highly important, labs report they are not performing well at reducing the risk of litigation due to inadequately preserved specimens.” Flooding and pest control are two often-noted issues. To reduce the risk of litigation, “labs should document storage-specific policies and develop procedures that includes regular audits of storage space and workflow processes.” This takes time and resources to enact.
Outsourcing specimen storage does not necessarily mean that all liability is shifted to the storage company — this depends on contract specifics and local laws. However, vendors that specialize in lab storage often dedicate significant resources to keeping best practices in place and protecting their facilities against natural disasters, which lifts some of the burden off of individual laboratories.
“In many climates, specimen storage requires rigorous controls, such as temperature and humidity monitoring, and even pest prevention,” the report states. Participants in the study almost unanimously claim to use temperature control like air conditioning, but fewer enforce controls around humidity and fire prevention.
As volume increases, it becomes more expensive and challenging to adhere to best practices for lab storage. With the fragmented reality that most labs face, specimens end up in multiple rooms with varying suitability for storage. Thus, the perception that onsite storage guarantees better care is often untrue.
Labs can solve the problem of quality control by consolidating into one space and consistently regulating that single environment. Reputable offsite storage companies work to maintain ideal standards for storage and can solve this problem when consolidation in-house is not an option. Either way, there is no 100% guarantee against disaster should a terrible accident or weather-related catastrophe occur. But fragmentation appears to be the riskiest scenario when speaking of day-to-day degradation.
Nailing down the economics of internal versus external storage proved tricky for Banker. “Participants state the costs to store specimens are low importance and for many this is because costs are absorbed at the corporate level,” she writes. Her research found that lab managers and directors perceived outside storage as pricier, but “there was no viable comparison as none were able to cite the actual cost of managing specimens in-house, including the real estate and resource line items on their budget.”
Without access to such information, Banker could not draw conclusions as to the economic tradeoffs of outsourcing lab storage. She notes, however, that organizations are actively seeking cost-saving measures given the drop in reimbursements — strategic use of space is certainly a part of that conversation.
Overall, the report found that a hybrid solution could suit the needs of most labs. The entirety of specimens rarely needs to be kept on site, but newer and more valuable specimens may make sense to keep in-house. According to the study, “on average, only about 10% of all slides and blocks are recalled at some point and most requests come within the first three years of slide/ block storage.”
To balance considerations of cost and accessibility, lab managers and directors might consider outsourcing blocks and slides over three years old. The right decision depends on specific lab circumstances, but this provides an easy rule of thumb to use as a reference.
Mapes is a Washington D.C.-based freelance writer and a regular contributor to Endocrine News. She wrote about the top scientific discoveries of 2016 in the December issue.