After years of scrapped plans to reorganize hospital labs, CTV Montreal has learned Montreal Health and Social Services will go ahead with a complete overhaul, despite very strong reactions from the medical and hospital communities.

For several years now, the health agency has repeatedly told hospitals about its plan to reorganize and centralize Montreal's hospital laboratories, which analyze tens of millions of blood and other samples for Montreal patients every year.

Last month the agency informed hospital administrators that they're going ahead with the project, called ‘Optilab,’ a system that relies on automation and groups tests by specialty and centre.

According to Montreal health agency documents, the Optilab project was created in September 2011 by then health minister Yves Bolduc. It is not a permanant organism or structure, but rather a working group that will help oversee, organize and analyze all possible avenues towards optimizing hospital biomedical labs.

Montreal’s health agency said it is trying to improve access to services, improve productivity, the sharing of infrastructure, sharing best practices, achieve and maintain a balanced budget.

Used in cities around the world, there some are serious concerns here about patient care, among others.

Other observations on the issue include:

  • A shortage of 250 laboratory technicians in Quebec and medical specialists in this field.
  • The costly replacement of equipment.
  • Past issues with quality assurance in the area of pathology.
  • 90 per cent of all bio-medical diagnostic tests are performed by 30 of the biggest labs. The 30 smallest labs only produce 3 per cent of the total volume.
  • Waits for appointments for tests is approximately 22 days, but the norm should be 14, and this directs people towards the private sector.
  • Many establishments have different information systems within same region. There would be a need to harmonize the systems to ensure network efficiency.

The agency says it wants feedback from all the major players involved, but many of the people affected told CTV Montreal that some decisions have already been made and that the overall framework has problems.

Those problems have led the Quebec Association of Microbiologists to hold emergency meetings. A member who contacted CTV said they were not consulted, and many said they feel as though the plan is being imposed upon them.

Problems will arise, for example, at St. Mary’s Hospital, which was the first in North America to develop a multi-disciplinary lab in 1995, and the first in Quebec to introduce automation.

St. Mary’s currently uses automated machinery that can perform at least 300 tests per hour. They are a referral centre themselves, analyzing samples from CSSS Cavendish, Mount Sinai, and the Douglas Hospital.

So why dismantle a lab that already provides a service to other institutions?

“(It’s) always to decrease the cost and improve quality. What also makes us special is we're the only lab in the province of Quebec in a hospital setting to be accredited by the American College of Pathologists,” said Ralph Dadoun, the vice-president of corporate services for the hospital.

Despite the rigorous standards and pioneering work, it does not seem to fit into the Optilab project.

"There is some added value in their proposal, but there are some major concerns,” said Dadoun, who said the hospital is not against change, but it wants to see the agency’s plan be modified.

The hospital has also invested a great deal of money into the lab over the years and has what’s considered to be excellent equipment.

The Montreal health agency has decided that within three to five years, certain hospitals will analyze certain specialized diagnostic tests.

“Right now we have 14 hospitals providing lab services,” said Frederic Abergel, director of medical affairs for the Montreal health agency. “In our plan, we want to concentrate most of the activities in five major centres.”

The designated five:

  • Jewish General Hospital
  • MUHC
  • Sacre-Coeur Hospital
  • CHUM
  • Maisonneuve-Rosemont Hospital

According to the plan, the other nine Montreal hospitals with labs would eventually start sending their vials and samples to partner hospitals for analysis.

CTV Montreal reporter Cindy Sherwin also learned that a virology lab will be centred at Sainte-Justine Hopsital because it has the expertise. Some doctors who did not want to be identified told Sherwin that there will be microbiology units at all five hub hospitals, but that they were told it would be taken out of the other nine hospitals altogether.

Those doctors told Sherwin they are upset about those changes, adding that they would want access to those labs for emergency rooms and admitted patients.

The agency said now a good time to do incorporate the changes because of advances in technology, and because superhospitals are currently under construction.

Further, they say doctors have been asking them for faster test results. A new reliable computer information system will be put in place to access those results.

Emergency services would be the exception, said Abergel.

“Every hospital with an emergency room will keep its lab services open to get emergency patients tested right on the spot,” he said.

St Mary's, for example, would be expected to send non-urgent tests to the Jewish General Hospital, or Pap tests to either CHUM or the MUHC, the new designated centres for cytology, reducing the volume of tests it performs in-house.

“The major issue is - maybe it's an oversight - but they forgot that we're a teaching hospital,a university teaching hospital affiliated with McGill, so we need the professionals to teach the residents, the future physicians. By reducing our volume to that extent, we won't be able to retain enough professionals internally to do that teaching,” said Dadoun.

The Montreal health agency said this reorganization will improve patient care.

“It will give them quicker access to the lab results so patients will wait less time,” said Abergel.

Microbiologists who contacted CTV Montreal, however, said those who practice as infectious disease doctors feel there are problems. For instance, they prefer to see the culture before a final result is in, because it helps guide treatment. Sending the culture out could compromise patients' health.

On a positive note, new blood-testing centres would be opened in Montreal and in the West Island.

“(It would) be open every night and on the weekends, so people who have to work during the day will be able to go at night or on the weekend,” said Abergel.

The logistics and practical details still have to be worked out, and they are significant.

Transport is one issue. Different sample require being kept at different temperatures as they move from the hospital to a central lab.

Further, the agency could not yet say how much implementation will cost or if the new revamped system will be cost effective.

“We know we will have to invest in some key areas, but the detail planning will give us more of a complete picture in the next few months,” said Abergel.

Impact on jobs

Francis Boucher of L'Alliance du personnel professionnel et technique de la santé et des services sociaux, a union of 30,000 professional and technical workers in the health care industry, said they don’t know yet what the impact will be on lab technicians. Whether they will be able to bump into other labs or into other hospitals, or if will they be forced to move or lose job remains to be seen.

The union will, however, ensure the health agency respects the collective agreement.

By the numbers

As of 2013, there were 97 establishments, including hospitals and clinics, operating labs that serve 7.8 million people in Quebec.

A total of 512 labs in these establishments include pathology, cytology, virology, hematology, blood banks, microbiology, genetics etc. and more.

In 2009-2010, these labs performed more than 148 million procedures with a $448 million operating cost.

Seven hospitals or hospital centres do 43 per cent of the total production in the province of Quebec

Phases of Optilab

First phase: Dec 2012 - Dec 2013
Organize all the tests and class them by complexity; choose best establishment (hospital) suited to produce them; establish the corridors of service (i.e. which hospitals will refer to other hospitals); organize a transportation system and computer system

Second phase: Dec 2013 - Dec 2015
Form and integrate the network of labs and professionals (the central hub hospitals, and the satellite hospitals); install services in areas that are not well served, such as blood-testing centres

Third phase: 2018
Prepare for large-scale automation of tests.