Switch from gel ABO/Rh to tubes for cost savings?

[Kathy]

If my calculations are correct, I can do tube types for about $1.50 each, but it costs me almost $4 each in gel. I have been ordered to reduce my costs by $1700 per month. We currently use tube typing for donor unit retypes and for retypes of new patients. If I switch manufacturers of tube typing antisera, use only tubes (get rid of the gel for blood types), and stop doing QC on my anti-C3b,d daily (only do on each day of use), I can save close to $1000 per month. Is this a bad idea? I do know from speaking with the gel manufacturer and from experience that the tubes show stronger ABO reactions, so I don't think I would be sacrificing quality. The only thing I don't know is the cost of biohazard disposal...the tubes are more bulky.

[Eagle Eye]

I do the same. First time Patient ABORH TyPE for patient by tube, donor retype by tube.

I validated donor retype by gel but did not implement as it is almost double then tube method.

I couldn't run it on ProVue as we need to validate export from ProVue.

[Malcolm Needs ☆]

The only thing that I would worry about is positive patient identification.

[Kathy]

Malcolm, how would positive patient identification be affected?

We don't have automation. Everything is manual.

[David Saikin]

Try putting pressure on your gel sales rep . . . probably won't work but is worth a try. All my techs are generalists . . . I debated the cost vs standardization and went for standardization. None of my staff can discern a mixed field ABO or Rh, not that you see it often but it can be crucial on occasion. Why not just stop using gel altogether - the savings would be tremendous and I don't think you would compromise pt care, after all, tubes were the standard for decades.

[Malcolm Needs ☆]

Malcolm, how would positive patient identification be affected?

We don't have automation. Everything is manual.

Ah, I didn't realise that Kathy - in that case it wouldn't and I withdraw my statement.

[Dr. Pepper]

Try putting pressure on your gel sales rep . . . probably won't work but is worth a try. All my techs are generalists . . . I debated the cost vs standardization and went for standardization. None of my staff can discern a mixed field ABO or Rh, not that you see it often but it can be crucial on occasion. Why not just stop using gel altogether - the savings would be tremendous and I don't think you would compromise pt care, after all, tubes were the standard for decades.

Excellent point Dave about the comforting lack of dead tube-tested patients over the years. One could use PEG in tube, which falls somewhere between LISS and gel for sensitivity. And I have always thought gel was technological overkill for routine ABO/Rh and especially donor retypes. You get nice reactions in tube with virtually all typings. Once in a while you might have to do a little more work like a cold backtype , but that's easy. Gel's sensitivity seems best suited for antibody detection.

If you're not doing electronic crossmatches yet and your LIS supports it, that can also save the price of a segment-piercing device for every IS crossmatch.

[JoyDenver]

Another reason to go back to tubes for ABORh is time. I never thought taking 10-15 min to do a blood type was very efficient, and the sensitivity is not sacrified.

[Eagle Eye]

we use gel as our primary method and for all patient without previous blood type---we do tube ABORH from same specimen. Very rarely we see a discrepancy where tech entered wrong/different patient's ABORH result and when we send result from automation, we get a flag in LIS.

I would not go back to all tube to save cost---If I ahve to justify the cost I would come up with so many reason on why I want to keep automation...

I do the same. First time Patient ABORH TyPE for patient by tube, donor retype by tube.

I validated donor retype by gel but did not implement as it is almost double then tube method.

I couldn't run it on ProVue as we need to validate export from ProVue.

[Brenda K Hutson]

Until coming to my current Facility, the other places I worked where GEL was used, only used the GEL technique for Antibody Screens and Antibody ID; all Blood Types (patients and units) were done by tube. In the place I am now (and have been for 8 months), they performed ALL Unit and Patient Typing by GEL; only a 2nd type on patients with no history, was performed in tube. With cuts in Healthcare these days, it is just too expensive for many places to use GEL for Blood Types. So, I just changed us from GEL to Tube for Unit Re-Types. The next "phase" will be to switch from GEL to Tube for Patient Types also. You are correct; it is a HUGE cost savings (sorry Ortho... I LOVE GEL but it call comes down to cost:frown:).

Brenda Hutson, CLS(ASCP)SBB

If my calculations are correct, I can do tube types for about $1.50 each, but it costs me almost $4 each in gel. I have been ordered to reduce my costs by $1700 per month. We currently use tube typing for donor unit retypes and for retypes of new patients. If I switch manufacturers of tube typing antisera, use only tubes (get rid of the gel for blood types), and stop doing QC on my anti-C3b,d daily (only do on each day of use), I can save close to $1000 per month. Is this a bad idea? I do know from speaking with the gel manufacturer and from experience that the tubes show stronger ABO reactions, so I don't think I would be sacrificing quality. The only thing I don't know is the cost of biohazard disposal...the tubes are more bulky.

[Mabel Adams]

It isn't really cheaper if you buy Ortho's tube typing reagents, but now that other vendors are in the market with much cheaper antisera, we are back to that situation of past years, aren't we?

[swede]

We will stick with gel/Provue for the majority of our typing. The Provue serves as a tech and frees up our techs to do all the other jobs that must be done on a daily basis. PMs and Nights are much more confident and happy working in blood bank since we went with gel and the provue. Peace of mind does not have a price!

[Kathy]

Unfortunately, budget cuts mean that automation is definitely not an option for us at this point...with Provues running close to $100,000. It is something we had thought of asking for within the next few years. I don't think we could reduce the number of techs since so much of our work is component preparation, so it would be hard to justify from a financial perspective. I do agree that the techs would like the automation and would be more comfortable with the blood bank...several of them are scared of the department since there is so much to remember. I think it would also be safer. We are doing manual testing, so the only advantage we get with gel for ABO typing is the standardization and clearer mixed field reactions. Other than that, in my opinion, tube wins for sensitivity and speed.

[swede]

Unfortunately, budget cuts mean that automation is definitely not an option for us at this point...with Provues running close to $100,000. It is something we had thought of asking for within the next few years. I don't think we could reduce the number of techs since so much of our work is component preparation, so it would be hard to justify from a financial perspective. I do agree that the techs would like the automation and would be more comfortable with the blood bank...several of them are scared of the department since there is so much to remember. I think it would also be safer. We are doing manual testing, so the only advantage we get with gel for ABO typing is the standardization and clearer mixed field reactions. Other than that, in my opinion, tube wins for sensitivity and speed.

We did not reduce our number of techs, we are just able to utilize our tech time better now with the ProVue....we were at the point of needing to ask for another tech (which with budget constraints we never would have been able to have one!). We were able to work out a "reagent rental" agreement with Ortho for our Provue, much like chemistry and hematology do with getting new equipment upgrades all the time. We also would not have been able to purchase the ProVue outright. I agree tubes are quicker, and we do use them when necessary for a trauma or other emergent case.

[Mabel Adams]

I think the new Ortho machine that is supposed to replace the Provue next year is maybe going to be cheaper than the Provue--or maybe that is just rumor.

[Brenda K Hutson]

According to my math, it will be cheaper for us. But maybe it has to do with Tiers, etc.? We are starting with changing our unit re-types to tube; but patients will be next on the list.

Brenda

It isn't really cheaper if you buy Ortho's tube typing reagents, but now that other vendors are in the market with much cheaper antisera, we are back to that situation of past years, aren't we?

[Barbarakym]

We did not reduce our number of techs, we are just able to utilize our tech time better now with the ProVue....we were at the point of needing to ask for another tech (which with budget constraints we never would have been able to have one!).QUOTE]

This is how the company sells these to adminnistration. I was at the meeting a few years back. Administration wants to cut people. SO last place I was at DID cut people to buy 2 provues. Now the people working there and are spread so thin stress is greatly increased. There is maintenance and problems that come up.... no workload units alotted for that of course. That is the danger of automation.IMO. Is expectations of labor savings. And there really is not any labor savings if it is done right (doing other things that we did not used to have time for......).

[Brenda K Hutson]

There is a lot to be said for Standardization of Reactions! That is one of the best qualities of GEL.

Brenda

Unfortunately, budget cuts mean that automation is definitely not an option for us at this point...with Provues running close to $100,000. It is something we had thought of asking for within the next few years. I don't think we could reduce the number of techs since so much of our work is component preparation, so it would be hard to justify from a financial perspective. I do agree that the techs would like the automation and would be more comfortable with the blood bank...several of them are scared of the department since there is so much to remember. I think it would also be safer. We are doing manual testing, so the only advantage we get with gel for ABO typing is the standardization and clearer mixed field reactions. Other than that, in my opinion, tube wins for sensitivity and speed.

[DPruden]

We had been doing all of our ABO/Rh testing in tubes, and then antibody screens and panels in gel. When we brought in the Echo a few years ago, we maintained doing all of our retypes in tubes, and kept gel as our antibody identification method. The drop in ordering volume made the price of the gel cards go up a lot, so that may be something to consider in your calculations.

[Changezi]

As reading all above for the donor retype using tube is fine as a time and cost saving .but as some one mentioned quality should consider

[Barbarakym]

As reading all above for the donor retype using tube is fine as a time and cost saving .but as some one mentioned quality should consider

I don't consider tube testing to be less quality as far as typing is concerned. It is faster and cheaper and all same doublechecks and pt ID is involved. Machines are not always right either. Just saying.

[Mabel Adams]

I think automation is less likely to sample the wrong specimen (as long as the human put the right barcode on it) so in that sense I think automation is safer. The machines don't get tired or distracted or stressed out from being yelled at by irrational physicians. Not that I think techs make a lot of specimen ID errors but one is too many.

[Likewine99]

Great comments on this topic! At my prior job (2 yrs ago) we moved as much testing to the Provue and gel cards that we could, the gel card pricing was cheaper than traditional tube reagents and this was based on our tiered pricing across the entire organization.

I think it's really hard to try to save a certain amount of money based on what the bean counters ask but I also don't think that you should waste time, reagents, etc. In today's lab environment I always felt it was hard to control pricing since most of that was negotiated way higher up the food chain than where I resided.

Another thought, look at where you have the most blood wastage. A certain nsg division, physician, outdated products on your shelf that kind of thing. It's another great place to see where you might have an opportunity to shave some $$ from your budget. Don't forget unnecessary OT, those 15 minute increments can wreak havoc with costs and budgets. I'm not advocating affecting patient care but if someone works over a bit shave it off the next day.

Good luck, I'm sure you'll get there!

[tupton]

Biorad (owner of Biosite) just had the FDA clearance on their version of Gel (which was developed in Europe way before Ortho got their hands on it. Once the US patent for Ortho's Gel expires this Fall you will see the price of Gel fall dramatically. I would bet it will be cut in half. Competition is a wonderful thing!

[Mabel Adams]

Last I heard from Bio-Rad they didn't plan to market gel in the US until about a year from now, even though the Ortho patent expires this fall. I look forward to the stimulating effects of competition too.