o Dispatch Systems
o Specimen Handling
Facility hires and trains
Part of the healthcare team
Dedicated to pick ups including
mail, x-rays, medical records,
hospitals, clinics, physician offices
and other departments
Facility pays for company cars,
salary and employee benefits
Contracted with an outside source
Logistics is managed by an
Employees hired and trained by the
Performance of courier outside of
hiring hospital’s control
A Mixture of the Two Systems
Internal couriers may be used for
established physician routes
External couriers may be used for routine
routes between hospital sites
External courier services may be used for
vacation, sick time, new routes, new
Internal couriers are supplemented using
outside sources for a variety of functions
Courier Employee Positives
Good for standard route pickups
Work long hours
Good employees, semi-retired
Good driving record
Valid driver's license
Good work ethic
Required to transport heavy packages
Working knowledge of municipal streets, state
highway systems, maps, GPS, etc.
External Courier Negatives
Not showing up for vacation
Not dressing professionally
Falter at handling MD offices not
knowing where to go to get
Calling off that day, not replacing
and not notifying customer
o Car maintenance
o Vehicles ($20K)
o Insurance ($150/mo)
o Gas credit card for
o Driver’s education
o Body work for fender
o Salary and benefits
1. Occupational Safety and
Health Administration (OSHA)
2. Centers for Disease Control
3. Department of
4. International Air
5. International Civil Aviation
6. World Health Organization
7. Clinical Laboratory
And More Regulations
College of American Pathologists (CAP)
The Joint Commission (TJC)
Food and Drug Administration (FDA)
State such as Ohio Department of Health
Health Insurance Portability and
Accountability Act (HIPAA)
Business Associate Agreements (BAA)
Does hospital send out staff need training if there is a courier packing the
If the staff is classifying/packaging specimens for transportation. The
hospital, clinic and doctor's office are considered the shipper of the
Does the person placing specimens into a box for shipment need to be
trained and certified?
Any persons handling specimens for transport must be trained and
certified to handle medical specimens.
What Category of specimens require Dangerous Goods Training?
Staff must be trained if providing specimens (dangerous goods) for
Where can lab staff/couriers receive training for Dangerous Goods
Employers must provide training for their employees.
IATA regulations require recurrent training every 2 years, unless there are regulation
changes prior to that time. DOT regulations require all training records be held as long as
the employee is retained and for 90 days thereafter.
Classification of Specimens
1. Exempt Human Specimens
Patient specimens where there is a minimal likelihood
that pathogens are present are not subject to these
regulations if the specimen is packed in a package
which will prevent any leakage and is marked with
the words “Exempt Human Specimen”.
2. Category B, Biological Substances (650)
UN3373; An infectious substance which does not
meet the criteria for inclusion in Category A.
3. Category A, Infectious Substances (620)
UN2814; An infectious substance which is transported
in a form that, when exposure to it occurs, is capable
of causing permanent disability, life threatening or
fatal disease in otherwise healthy humans.
Packing methods and shipping guidelines are important in assuring quality
patient care and maintaining specimen integrity .
For the safety of others, specimens need to be classified into respective
Standardized methods and procedures so that all specimens are
packaged and transported correctly.
The temperature at which specimens are held and or transported is a
critical component and different packaging will be needed for frozen,
refrigerated and ambient temperatures to achieve optimal
environmental control during transit.
Additional steps may need to be taken in seasons/locations where
extremes of heat or cold could affect specimen integrity.
Basic infection control procedures must also be followed, including
adherence to universal precautions protocols.
OSHA mandates all body fluids be considered potentially infectious and
that appropriate engineering and work practice controls be
implemented while handling the specimen.
o Shipper Marking: Indicating the
name and address of the
o Consignee Marking: Indicating
the name and the address of
the intended receiver of the
o Responsible Party Marking:
Indicating the name and phone
number of a person “responsible
for the shipment”
o Class 6 Infectious Substance
Label: Indicating shipment
contains Category A Infectious
Substance Affecting Humans
o UN Specific Label UN2814
Dry Ice Label
Class 9 Miscellaneous
o The quantity must be
included on this label as
(___kg). (no more than 2.2kg
of dry ice is allowed per
o Double up arrows pointing
upwards must be on
opposing sides of the box.
o Place the pre-packed tape
strip across the box only in
o Care should be taken to
allow enough space for
carbon dioxide gas to
escape as dry ice dissipates
Exempt Human Specimens are not regulated by
Category A and B specimens are regulated by the
Dedicated private or contracted carrier is defined
as a motor vehicle used exclusively to transport
biological substances or biological products.
While other medical or laboratory related
materials may also be transported in this
vehicle, its purpose is primarily to transport
o Charter, Commercial and Cargo Aircraft
are used for transportation of specimens
to reference laboratories .
o IATA regulations must be followed for all of
the listed air transport options.
o Regulations include procedures for Dry
Ice, Category A versus Category B
specimens, labeling of shipments, and
any documentation guidelines.
Factors Which Can Damage
a Specimen During Transportation
Not being able to:
Use a seat belt on cooler and place
cooler in back or place on floor so the
specimens are not jostled.
Keep tubes upright for proper position
during clotting and transportation.
Division of cooler for ice and room
temperature to maintain integrity.
Lost or Compromised
specimens major source of
physician and patient
o Losing specimens
o Not picking up in a timely
fashion or forgetting pickups
o Not emptying coolers
o Not maintaining the
appropriate temperature for
stability resulting in poor
Laboratory Tests Affected by Hemolysis
orus, LDH, TP, AST, a
Fe, Ca, ALT
RBC, Hgb, Hct
Red blood cells (RBC), perhaps, perform the
most important duty in the body when it
comes to blood. These cells carry oxygen
from the lungs and deliver it to the rest of the
body. Also, they bring carbon dioxide back to
the lungs so that it can be exhaled.
Not having enough red blood cells deprives
the body from getting the amount of oxygen
required for its functioning. This condition of
low red blood cell count is called
anemia, and it may indicate several factors.
Decreased RBC Diseases
Vitamin B12 or Folate Deficiency
Bone Marrow Insufficiency
Iron Deficiency Anemia
Aspartate aminotransferase (AST) in
liver, heart, and muscle
Alanine aminotransferase (ALT) found in
Uric acid gout and poor diet
Total bilirubin in obstructive jaundice
Lactic acid dehydrogenase (LDH)
elevates in response to cell damage
Need to know neighborhood and routes
Online system to order stats
Can check back on specimens
Maintain the routes as physicians are
added or lost
Rearrange routes to be productive
Know where the specimens are at all
Change specimen pick up times
Courier Software Solutions
Streamline the process
Ensure reliability and accountability
Easy to use
Manage delivery system
Integration with other components and
The level of expertise and the
performance expectation bar just keeps
o Order entry
o Geographical footprint
o Virtual nationwide network
o Allows for the laboratory to plan workload and staff
o Able to re-route drivers due to weather, STATS, or other
Planning for expected volume of
Allows for the customization of
billing, rates and services
Dispatches know exactly where the
drivers are, what specimens they have
Track orders on line
Delivery status, proof of delivery
Variety of management reports
Designed to fit specific customer needs
What does that mean?
The official name for "ObamaCare" is the
Patient Protection and the Affordable Care
Act, a bill signed into law to reform the health
ObamaCare requires that all insurance plans
cover preventive services and stops insurance
companies from dropping people when they
are sick, as well as offering a number of other
reforms and protections.
ObamaCare Medicare Advantage
The ObamaCare Medicare cuts will mainly affect
reimbursement rates for hospitals and private
health insurance companies.
ObamaCare also seeks to decrease the amount
paid to hospitals for Medicare.
Hospitals have already agreed to this practice
since everyone has insurance under the
Affordable Care Act.
Systems will see a large influx in the amount of
visitors to their hospitals, thus they should break
even or possibly profit, while saving the tax payers
ObamaCare's new Medicare Value-Based Purchasing
Program means hospitals can lose or gain up to 1% of
Medicare funding depending on 20 factors that gauge
quality v. quantity care.
Hospitals are graded on a number of quality measures
related to the treatment of patients with heart attacks, heart
failures, pneumonia, certain surgical issues, re-admittance
rate, as well as patient satisfaction.
The ratings will be measured by the Hospital Consumer
Assessment of Healthcare Providers and Systems (HCAHPS).
Hospitals have substantial incentives to make sure
employees understand the legislation’s components, the 3rd
party HCAHPS process, and strategies to maximize efficiency
and customer service.
Value-based Payment Rewards
Hospitals for Providing Quality
In other words if a hospital has a high re-admittance
rate or rated poorly for treatment they can lose a
percentage of funding or if they have a low re-
admittance rate or score well they can gain funding.
Some hospitals have already been hurt, while others
have gained significant funding. Although the
drawbacks are obvious in the short term it has created
an incentive to improve the quality of care in hospitals.
ObamaCare Medicare penalties / rewards will rise over
the next two years to a total of 2%.
26% of the U.S. federal Budget
Medicare providers will see $11 billion in
reimbursement cuts in 2013
Deficit reduction sequester was designed to
achieve savings of $1.2 trillion through 2021
Millions of dollars in Medicare reimbursement
are at stake for health care providers that
succeed or fail to navigate health care
There are 9757 companies labeled as
Approximately 5,815 Registered Hospitals
in the US.
5,010 Community Hospitals
213 Federal Government Hospitals
447 Non Federal Psychiatric Hospitals
129 Non Federal Long Term Care Hospitals
16 Hospitals of Institutions(Prison Hospitals,
College Infirmaries etc...). (Wiki Answers, 2013)
Think of All the Work!
According to a report by the US Census
Bureau there were over 661,400 doctors and
surgeons practicing medicine in 2008. In 2003
the US Department of Labor broke down the
categories to include 23,790
Anesthesiologists, 111,990 General
Practitioners, 50,140 Internists, 19,180
OB/GYNs, 26,910 Pediatricians, 19,530
Psychiatrists and 49,730 Surgeons. (U.S. Department of
Labor, Occupational Outlook Handbook, 2012-13 Edition, Physicians and Surgeons,
on the Internet at http://www.bls.gov/ooh/healthcare/physicians-and-surgeons.htm (visited
June 23, 2013).
So What’s Next?
Win for the Courier Win for the Healthcare system
Willing to pay more for
o Simplify process
o Cost containment
o Quality patient
Laboratory professionals work in one of the
most highly regulated environments in health
Small changes can be very difficult due to
time, budget and staffing constraints
Very difficult for laboratories to maintain a
high performing, cost effective courier service
Decreasing reimbursement environment and
tight budgetary constraints for capital
Competition between facilities
Physicians, nurses, other ancillary
departments for care coordination
Tough performance standards need to be
Managerial expertise are needed to run
Look at ways to reduce costs and
Integration of services