During the initial contain phase, the number of tests run was high. On June 1, the day of peak testing, 1,401 PCRs for influenza were performed, this being the sum of the matrix gene PCRs performed on each referred specimen and HA gene PCRs performed on matrix gene PCR-positive samples (). In contrast, a typical daily peak number in winter would be ≈100. However, the laboratory was able to sustain peak levels of influenza testing and provision of results within typical turnaround times. The times from specimen data entry into the laboratory information system to result reporting were calculated by extracting data from the Laboratory Information System (Medipath, LRS Health; Melbourne, Victoria, Australia) with an integral analytic software module. Because the actual time of specimen arrival is not searchable on our system, the representativeness of this electronic data as a proxy for total test turnaround time was verified by a manual audit of 200 Medipath files. This procedure compared the manually stamped arrival time and date on scanned digital images of specimen request forms received on June 1, the busiest day of the outbreak, with the corresponding time and date recorded electronically for result reporting. This manual audit gave a faster estimate for turnaround time than the electronic search, probably because the latter includes data from weekends (data not shown).
Number of diagnostic specimens received at the Victorian Infectious Diseases Reference Laboratory and laboratory detections of pandemic (H1N1) 2009 virus, Victoria, Australia, 2009.
The mean turnaround time from specimen data acquisition to result reporting for the 4 peak months of the 2009 outbreak was <24 hours (). For all except a 2-week period in June, this turnaround time was faster than the equivalent turnaround time for the winter of 2008. The main contributors to this outcome were longer than usual working hours for scientific and support staff, coupled with high levels of automation.
Mean turnaround times for Victorian Infectious Diseases Reference Laboratory detection of influenza, Victoria, Australia, 2008 and 2009.
Specimens were transported by courier to VIDRL from Melbourne hospitals, other laboratories, and general practitioners on behalf of Victorian health authorities. The duration of time from specimen collection to arrival at VIDRL varied. Transport times for all pandemic (H1N1) 2009–positive samples were calculated by comparing the interval between the laboratory receipt time and date stamp and the recorded collection time and date on digital images of specimen request cards. Positive samples were chosen for analysis because of the relative ease with which this dataset could be collated from the laboratory information system. The positive samples were representative of the total sample group from which they came; ≈15% of positive specimens arrived on the day of collection, 40% arrived the next day, and ≈30% arrived over the next 2 days (). Despite maintenance of typical test turnaround times, these transport times contributed to clinicians’ perception of slow turnaround times (4
), for which VIDRL received numerous complaints. During the pandemic, it was common to receive telephone inquiries for results for specimens that had arrived only hours earlier or had yet to arrive.
Timing of receipt of pandemic (H1N1) 2009 virus–positive specimens by the Victorian Infectious Diseases Reference Laboratory, Victoria, Australia, 2009.
Our pandemic planning had focused primarily on resources and processes under our control within the laboratory. However, for optimal functioning of the whole testing cycle, the movement of specimens and accompanying data from patient to testing site and provision of results back to the patients’ caregivers must also be optimal. To do so required a systemwide planning approach that was less than complete at the onset of the pandemic. More planning will be needed for optimal functioning under the pressures imposed by a future large outbreak ().
Summary of laboratory effectiveness during pandemic (H1N1) 2009, Victoria, Australia, 2009