title: An Assessment of the State of Current Practice in Coagulation Laboratories.
abstract: OBJECTIVE
  To assess the state of current practice in coagulation laboratories regarding three pressing issues: staffing, handling Ebola specimens, and testing/billing for tests that measure direct oral anticoagulants (DOAC).
  
  
  METHODS
  A survey and analysis of specialized coagulation laboratories in North America was conducted.
  
  
  RESULTS
  Approximately 4,000 special coagulation tests-per-technologist-per-year was rated as either a "good" staffing level or "adequate-but-ideally-need-more" employees. Requiring technologists to perform more than that was rated as an "inadequate" staffing level. For Ebola patients, coagulation testing is mostly performed by point-of-care. Only 26.1% would perform coagulation tests for Ebola specimens within their laboratory (rather than at the bed side or a separate designated space outside the laboratory). Coagulation tests offered for Ebola patients were limited: prothrombin time (63.0% of laboratories), activated partial thromboplastin time (37.0%), D-dimer (13.0%), and fibrinogen (8.7%); 26.1% of laboratories did not offer any coagulation tests for Ebola patients. Approximately 35% of special coagulation laboratories bill for at least one laboratory test for DOACs: 33% bill for an anti-Xa calibrated with rivaroxaban, 17% bill for an anti-Xa calibrated with apixaban, and 27% bill for at least one of several tests for dabigatran. Approximately 48% do not offer any tests for DOACs.
  
  
  CONCLUSIONS
  These results may help laboratories negotiate for additional technologists if needed, prepare for Ebola specimens, and manage the demand for laboratory tests for new DOAC anticoagulants.
authors: From the Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis;
authors: Nicole D
authors: ND
authors: Zantek
authors: Department of Pathology and Molecular Medicine and Medicine, McMaster University, Hamilton, Canada;
authors: Catherine P
authors: CP
authors: Hayward
authors: Department of Pathology, Massachusetts General Hospital, Boston;
authors: Trevor G
authors: TG
authors: Simcox
authors: Department of Pathology, University of Utah, ARUP Laboratories, Salt Lake City; and.
authors: Kristi J
authors: KJ
authors: Smock
authors: Department of Pathology/Laboratory Medicine, Hofstra North Shore-Long Island Jewish School of Medicine, Lake Success, NY.
authors: Peihong
authors: P
authors: Hsu
authors: Department of Pathology, Massachusetts General Hospital, Boston;
authors: Elizabeth M
authors: EM
authors: Van Cott
mesh_terms: D001780:Blood Coagulation Tests / Q000592:standards*; D019142:Hemorrhagic Fever, Ebola / Q000175:diagnosis* / Q000473:pathology; D006801:Humans; D007755:Laboratories, Hospital / Q000592:standards*; D019095:Point-of-Care Systems; D013048:Specimen Handling / Q000592:standards*
keywords: Apixaban; Dabigatran; Direct oral anticoagulant (DOAC); Ebola; Rivaroxaban; Specialized coagulation laboratory; Staffing