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Clinical Laboratories and Pathology Groups

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Clinical Laboratories and Pathology Groups

Hosted by Robert Michel
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Increased Testing Demands from Physicians is Putting New Zealand Clinical Laboratories Under Severe Stress

Following the loss of its histology accreditation, pressure on APS laboratory continues to mount

Government-run healthcare systems around the world often under-invest as demand grows and new healthcare technologies enter clinical practice. One such example is taking place in New Zealand, where public pathology and medical laboratory services are under extreme stress as physician test orders exceed the ability of the island nation’s clinical laboratories to keep up.

“The escalating pressure is complicating what was already a very difficult rescue job at one of the country’s busiest labs—Community Anatomic Pathology Services (APS),” RNZ reported. In 2023, APS lost its histology accreditation after it came to light that lab workers were not only exposed to toxic chemical levels at the facility, but that patients were waiting weeks for test results to return from the lab.

This follows a 2021 report from consultants PricewaterhouseCoopers (PwC) to the Auckland District Health Board in which New Zealand health authorities received warnings to improve pathology systems.

“The service is in crisis mode and, without urgent investment … there is a real risk that it will fail. The changes required are of such urgency that it is recommended that they be placed at the top of the agenda,” the report reads, RNZ reported.

“The size of New Zealand’s economy is restricting what our country spends on health. Health is already the second highest demand on the New Zealand tax dollar,” wrote Andrew Blair, CMInstD (above), then General Manager of Royston Hospital, Hastings, New Zealand, in an article he penned for Jpn Hosp, the journal of the Japan Hospital Association. “The tolerance of New Zealanders would be challenged if a government attempted to increase taxes further to meet the growing demands for expenditure on health, but at the same time the population’s expectations are increasing. This is the challenging situation we face today.” For New Zealand’s clinical laboratories, the demand for testing is increasing annually as the country’s population grows. (Photo copyright: Blair Consulting.)

Increased Demand on APS Leads to Problems

Established in 2015, APS tests thousands of anatomic and tissue samples yearly and is utilized by approximately a third of NZ’s population, according to RNZ.

The big story, however, is that from 2022 to 2023 utilization increased by a third. “The overall increasing demand is greater than the capacity of the service,” Te Whatu Ora (Health New Zealand), the country’s publicly-funded healthcare system, told RNZ.

As planned care increased, public hospitals started outsourcing operations to private surgical centers. A domino effect ensued when all of those samples then made their way to APS. There was an “increased volume of private surgery being carried out by 600 specialists in the region and 2,000 general practitioners, with up to 450 histology cases a day,” RNZ noted, adding, “The backlog has hit turnaround times for processing samples, which had been deteriorating.”

To make matters even more dire, working conditions at the country’s clinical labs is unfavorable and deteriorating, with short staffing, outdated workspaces and equipment, and exposure to dangerous chemicals.

In “New Zealand Clinical Laboratories to Undergo Health and Safety Checks after Workers Contract Typhoid, Others Exposed to Chemicals,” Dark Daily covered how Health New Zealand recently ordered health and safety checks at multiple clinical laboratories in 18 districts across the country. The action is the result of safety issues detected after procedural discrepancies were discovered in separate labs and follows months of strikes by NZ medical laboratory workers seeking fair pay and safe working conditions.

“Conditions got so bad from 2019-2021 that workers were exposed to cancer-causing formaldehyde in cramped workspaces, and flammable chemicals were stored unsafely,” RNZ reported.

While pay increases and safety improvements have provided some relief, the memory of past incidences coupled with increasing delays continue to undermine confidence in New Zealand’s laboratory industry.

Patients Also at Risk Due to Long Delays in Test Results

“We recognize the concern and impact any delayed results can cause referrers and their patients,” Health New Zealand said in a statement, RNZ reported.

Nevertheless, a 2023 article in The Conversation noted that, “38,000 New Zealanders had been waiting longer than the four-month target for being seen by a specialist for an initial assessment.”

These backlogs can be especially deadly for cancer patients. In “Pathology Lab Shortages in New Zealand Are One Cause in Long Delays in Melanoma Diagnoses,” Dark Daily detailed how patients awaiting melanoma diagnoses are experiencing delays upwards of one month due to long waits for test results.

However, according to plastic surgeon and Melanoma Network of New Zealand (MelNet) Chair Gary Duncan, MBChB, FRACS, when patients return to their doctors for test results, those results often have not come back from the medical laboratory. Therefore, the physician cannot discuss any issues, which causes the patient to have to make another appointment or receive a melanoma diagnosis over the telephone, RNZ reported.

“Slow pathology services are unfair to patients. Such delays could result in the spreading of the melanoma to other parts of the body and require major surgery under anesthetic,” dermatologist Louise Reiche, MBChB, FRACS, told RNZ. “Not only will they suffer an extensive surgical procedure, but it could also shorten their life.”

Improvements at APS Underway

Changes are currently underway that may decrease the long delays in test results at New Zealand’s labs. “A business case was being done to set up an electronic ordering system to cut down on manual processing errors,” RNZ reported.

Additionally, “the situation is much improved due to dispersal of work around [the] city and country for now. The teamwork around the region has been a veritable lifesaver,” a source familiar with the work told RNZ.

Construction of a new lab for APS is also allegedly in the works. However, to date no announcement has been made, according to RNZ.

Time will tell if New Zealand’s government can repair its pathology system. News stories showcasing damage caused by lengthy delays in clinical laboratory test results—and the ensuing patient harm due to rationed care in general—continue to reveal the weakness in government-run healthcare systems.

—Kristin Althea O’Connor

Related Information:

Private Healthcare Pushing Auckland Labs to the Brink

Te Whatu Ora Pathology Service Provider Loses Accreditation

NZ’s Health System Has Been Under Pressure for Decades. Reforms Need to Think Big and Long-Term to Be Effective

Meeting Increased Demand

Eight-Week Wait for Skin Cancer Test Results Risking Lives-Doctors

Pathology Lab Shortages in New Zealand Are One Cause in Long Delays in Melanoma Diagnoses

Te Whatu Ora Tight-Lipped on New Auckland Pathology Lab

Pathology Lab Shortages in New Zealand Are One Cause in Long Delays in Melanoma Diagnoses

Similar diagnostic delays due to clinical laboratory staff shortages are reported in other nations as well

Critical pathology shortages are causing lengthy delays for clinical laboratory test results in New Zealand, according to a report that states some patients are waiting over a month for a melanoma diagnosis. This situation puts the lives of cancer patients at risk in the island nation. 

The Melanoma Network of New Zealand (MelNet) is working to reduce the number of people who develop the disease and help melanoma patients receive a fast diagnosis and proper treatment and care.

However, plastic surgeon and MelNet Chair Gary Duncan, MBChB, FRACS, told Radio New Zealand (RNZ) that when patients return to their doctors for test results, those results often have not come back from the medical laboratory. Therefore, the physician cannot discuss any issues with the patient, which causes them to make another appointment for a later date or receive a melanoma diagnosis over the telephone, RNZ reported.

Dermatologist Louise Reiche, MBChB, FRACS, told RNZ that slow pathology services are unfair to patients. Such delays could result in the spreading of the melanoma to other parts of the body and require major surgery under anesthetic.

“Not only will they suffer an extensive surgical procedure, but it could also shorten their life,” she said.

Trishe Leong, MB.BS (hons) Medicine, FRCPA Anatomical Pathology

“We’ve got shortages across the board, and it only seems to be getting worse,” said Trishe Leong, MB.BS (hons) Medicine, FRCPA Anatomical Pathology (above), President of the Royal College of Pathologists of Australasia (RCPA). She added that “there was also a backlog of pathological examinations of placentas, which are used to detect genetic conditions and shed light on complex births,” The Sydney Morning Herald reported. Clinical laboratories in several countries worldwide are experiencing similar delays in reporting critical test results to physicians and their patients. (Photo copyright: RCPA.)

Pathology Labs Cannot Meet Demand for Testing

The Royal College of Pathologists recommends that 80% of specimen results should be returned to clinicians within five days. General practitioner Jeremy Hay, MD, of the Upper Hutt Skin Clinic told RNZ that he has never seen a melanoma report returned from the laboratory he utilizes within the suggested five-day time span. He stated that his local pathology lab simply cannot meet the demand for the vast number of samples waiting to be tested.

“I have visited the lab, and you can see even in the corridors stacks of unreported slides sitting outside the pathologist’s rooms, and there are more inside their rooms,” he said. “They need more staff and that’s quite obvious.”

Hay added that, because of the delays, he typically does not start with a small biopsy of a suspicious-looking piece of skin. Instead, he just cuts the entire area out and sends it to the lab for testing to expedite the diagnosis process.

Lab Loses Accreditation Due to Delays

Long delays caused one lab—Auckland’s Community Anatomic Pathology Service (APS)—to lose its accreditation for the lab’s skin testing department. According to RNZ, some patients had to wait up to eight weeks to learn whether they had melanoma.

An article published by medical/science specialty recruiting firm Odyssey, states that the deficiency at APS was due to several factors, including:

  • Population growth.
  • An increase in private medical practices.
  • The underestimation of the costs required to run the lab.
  • An overestimation of potential savings.
  • A shortage of qualified pathologists, specifically in the fields of anatomical, chemical, and forensic pathology.

The article also states that pathologists are now listed on Immigration New Zealand’s list of shortage skills in the country. That designation means that foreign candidates who have the skills, and who are offered jobs in the country, can immediately apply for permanent residency. 

Three Week Wait for Cancer Diagnoses in Australia

According to the World Cancer Research Fund International (WCRF), New Zealand has the second highest rate of melanoma in the world. The number one spot is held by Australia. 

Other countries are experiencing long wait times for cancer diagnoses as well. According to The Sydney Morning Herald, some individuals are waiting up to three weeks to receive a cancer diagnosis due to a shortage of pathologists.

“It could be the cancer you didn’t suspect,” said Trishe Leong, MB.BS (hons) Medicine, FRCPA Anatomical Pathology, President of the Royal College of Pathologists of Australasia. “There’s always the chance of something unexpected showing up in a biopsy, and if that is not tended to as soon as possible it can have an impact on patient care.”

This is not the first time Dark Daily has reported on clinical laboratory staff shortages around the world causing huge test result delays.

In “Irish Cancer Society Report Shows Patients May Wait Two Years or More for Genetic Cancer Test Results,” we covered research conducted at the University of College Cork (UCC) which revealed that genetic services have been “starved of investment and resources” in the Emerald Isle, leaving healthcare workers involved in cancer genetics and follow-on services “completely overstretched.”   

And in “In Canada, Shortage of Medical Laboratory Technologists and Radiology Technicians Continues to Delay Care,” we reported how varies combinations of facility, physician, and other healthcare professional shortages are generating regular headlines about patient wait times in the UK, Canada, New Zealand, and Australia, particularly for elective procedures that may be six months to a year or more.

In those countries, and around the world, healthcare experts say the solution is expanding training opportunities to solve the shortage of clinical laboratory scientists, medical laboratory and imaging technologists, doctors, nurses, and other medical professionals, and increasing funding for modernizing hospital facilities and clinics.

But in countries with government-run healthcare, that solution is problematic at best.

—JP Schlingman

Related Information:

Eight-week Wait for Skin Cancer Test Results Risking Lives – Doctors

Private Healthcare Pushing Auckland Labs to the Brink

Factors Increasing Demand for Pathology Services in Auckland NZ

‘The Cancer You Didn’t Suspect’: Medical Test Delays Could Be Endangering Patients

Irish Cancer Society Report Shows Patients May Wait Two Years or More for Genetic Cancer Test Results

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