STAT Medical Courier Deliveries; If you manage a laboratory, hospital network, specialized medical facility, or pharmacy, it’s very probable that you recognize that each specimen is far more than simply a container. This container could hold a blood sample used to determine whether a patient will receive surgical intervention, a tissue biopsy to aid in guiding treatment for cancer, or a sample related to transplantation that cannot be delayed by traffic. Therefore, the courier delivering the specimen isn’t merely delivering a package. They are delivering a component of a clinical decision.

But when most companies look for a medical courier service, they tend to look at how much it costs per mile. Most companies also reduce the services provided by the courier (which determine whether a sample will be delivered within a specific timeframe) into columns of data in a rate sheet or into paragraphs of terms and conditions that most likely won’t even be read until a problem arises.

Due to the differences described above, there are also other differences between “STAT” runs and “routine” runs in addition to the obvious difference in speed. The two types of runs have many other differences, including: – Dispatch rules – Driver assignment – Guarantee policies – Pricing structure – Results of errors (e.g., missed deadlines)

This guide points out all the differences in the small print so you can easily see them. No matter if you’re looking for a new vendor or evaluating your current vendor, you’ll find out how STAT Medical Courier Delivery works, what is considered “Routine” within STAT, and what types of service combinations would provide the best patient care and be cost effective.

What Does “STAT” Actually Mean in Medical Courier Delivery?

The term “STAT” is derived from the Latin word “statim,” which means “immediately.” In hospital settings, “STAT” is often used as a shortened form of an order that requires immediate attention. Similarly, in the courier industry, “STAT” refers to a dedicated delivery service where the pickup occurs as soon as possible, the delivery occurs as quickly as possible, and there are no additional stops made along the way.

That definition seems very clear and simple, however there are many specific commitments associated with it.

The core features of STAT medical courier delivery

• The delivery will take place as soon as the order has been received. There is no waiting for the next hour to begin before we assign a delivery person.
• Direct routing – This is where the driver takes a package directly from the place of pickup to its final destination, while not collecting additional packages en route.
• The only thing the driver does during this trip is transport the load. There are no other shipments being transported by the same driver at the same time. The only focus of the driver and the only use of the vehicle is for the delivery of the shipment.
• Real-time tracking and communication. The sender and receiver have the ability to track the status of the shipment in real-time, and if there are any updates or issues, they can speak with a live dispatcher.
• All transactions are documented with a chain of custody. Each transaction will be documented from the time a sample is taken until such time as the sample is received by the person who signs for it.

Note that there’s nothing about a universal time guarantee listed above. It’s at this point that you begin to see how the fine print matters. The term “STAT” refers to a type of service, rather than a generally accepted legal term. A company providing STAT service might promise to pick up your package within 30 minutes. A different company providing STAT service might promise to deliver your package by a particular time. Still another company providing STAT service might say they’ll make every attempt to get your package delivered as quickly as possible (“best effort”). I’ll explain more about why some companies don’t include all of these details in their terms of use/service agreements in the section titled “What Companies Bury.”

Why the word gets misused

Because the term “STAT” conveys urgency, it has become common practice to stamp it onto nearly all requests. Many clinics now use the label STAT for all of their requests, having found that this is an effective way to obtain a rapid response. Additionally, there are many couriers advertising “STAT” services who in reality are providing those services as an expensive hot-shot addition to a multi-stop delivery route. Therefore, when every single delivery request is marked as “STAT”, then none of them can be truly urgent; and as such, the deliveries that are truly urgent do not receive the clear designation needed for prioritization.

A successful STAT program will have well-defined criteria, established commitments, and clear accountability. If a program does not meet these requirements it is merely an advertisement.

What Is a Routine Medical Courier Run?

Routine service forms the basis for a majority of all medical logistics programs. Routine service includes the predictable, repetitive, scheduled transport of specimens, records, supplies and pharmaceuticals to/from established locations.

Imagine the day-to-day operation of picking up laboratory samples from a network of doctors’ clinics. A driver has an assigned route, picks up sample containers at each clinic on his route, and drops off those samples at the main reference laboratory so that they can begin being processed. The route may be identical daily. Pickup times are agreed upon before the route is completed. Many stops on the route use the same vehicle, and this is why the cost per stop is relatively low.

The core features of routine service

• Scheduled pickups. Runs happen at set times or within set in windows.
• In multi-stop routes, one driver visits multiple locations to spread the cost among multiple clients.
• Predictable volume. Both sides know roughly what to expect each day.
• Lower cost per delivery. Shared routes mean shared expense.
• Defined cutoff times. Specimens must be ready by a set time to make the route.

Routine does not imply lack of care. A successful routine program continues to follow strict processing, temperature control, and documentation procedures; however, the sense of urgency has been transferred from the individual test order to the routine route itself. Many laboratory tests have been developed to be processed within 24 hours (or early the following morning) of collection. Therefore, routine routes are constructed to reliably maintain this pattern of processing.

Where routine service shines

Routine run is what most medical shipments require (i.e. standard blood work, urine, and cultures that have normal stability periods; routine supplies, and recurring pharmacy orders). It would be as if you took an ambulance to your yearly physical exam if you paid STAT prices for these types of shipments.

STAT vs. Routine: Side-by-Side Comparison

The table above shows the most common differences between both types of service providers. Although each service provider has its own terminology and specifics, it can be used to differentiate the two.

The principal finding from comparing the two services is that STAT and routine do not compete with one another. On the contrary, they complement one another. Therefore, it is suggested that you design your programs around using routine service for predictable volume and have STAT as a backup when prompt response is required.

How Couriers Decide What Gets Prioritized

When clients rarely get a glimpse of how medical courier providers prioritize their requests, this is where the quality of the provider becomes apparent. If multiple requests come in at the same time, who determines the order in which they will be fulfilled, and on what basis?

A professional medical courier operation uses a layered system.

Layer 1: The service level you purchased

The initial element was based on the level the customer chose. A STAT order overrides standard route operations. This is exactly what customers pay for. An established service provider will have both the ability and the organizational structure to handle this override with out merely taking drivers away from their regular routes and hoping that no one will notice.

Layer 2: Clinical urgency and specimen stability

There is a difference in the length of time that different specimens can last once they are removed from the body. Some types of testing require the specimen to reach the lab during a very specific amount of time after removal, while others will remain valid for several hours, or even days, as long as they are stored properly. Medical dispatchers who are knowledgeable about medical logistics use these factors when planning their work. If there is a routine pick-up that includes a specimen with a short-term stability factor, the dispatcher may decide to schedule the pick-up for a time prior to when the routine route was originally scheduled.

Layer 3: Distance, traffic, and driver availability

As you can see, even in cases of emergency requests, location counts. A dispatching system and an experienced dispatcher evaluate where each driver is located, how long the trip will be based on present circumstances, and what order should receive the sample first to get it to its destination as quickly as possible. Just because a driver is closest to you does not mean that he/she would make the best selection, especially if he/she has a load of products that are susceptible to heat damage, and therefore cannot be interrupted.

Layer 4: Conflicts and escalation

When you have a number of immediate requests coming in simultaneously, the provider needs to have a formal process to handle these types of situations. An operationally successful organization will have a structured process for handling this type of situation contact the patient; find out what is truly clinically important and then assign resources based on that information. Conversely, an operationally unsuccessful organization will permit whoever is answering the phone to determine how to proceed.

Why transparency here is a competitive advantage

Many providers don’t take the time to explain the process for resolving conflicts to their customers. Instead, they just state that they give priority to those issues which require immediate attention. A provider who takes the time to go step-by-step through the process used to resolve conflicts is one that has spent time considering those issues.

The Dispatch Process Behind a True STAT Run

The reason that the STAT service is more expensive than other services, and why it must be so, can best be understood by following a single request through the entire process.

Step 1 and 2: Order Received and Driver Assigned

Step 1: The order is received. At the time a clinic/laboratory contacts us via phone, text, or website (and submits a request marked as STAT), the top performing providers will immediately begin asking the right questions: where do I need to go to obtain the sample; where do I need to take the sample; what kind of specimen am I picking up; does the specimen require a specific temperature during transport; and when does the order need to be completed.

Step 2: Dispatch immediately assigns a driver. The dispatcher selects the best driver for each job based on where he/she is located, what type of truck/van he/she is driving, and if the delivery requires any special treatment. The selection of a driver is completed in minutes and does not wait for the driver to finish their last scheduled stop.

Step 3 and 4: Pickup and Documentation

Step 3: The driver heads to your pickup point. Once the driver accepts the ride, you will receive a notification of acceptance along with an ETA. The driver will make no stops on their way to pick you up.

Step 4: Pickup & Documentation. The driver will verify that the specimen is consistent with the documentation, note the date/time of pickup, the appearance of the specimen upon receipt and store the specimen in an appropriate container. If a sample needs to be refrigerated or has other special requirements (e.g., maintained within a specific temperature range), the sample must be stored in the proper location inside the vehicle before driving.

Step 5 to 7: Transit, Sign-Off, and Delivery Confirmation

Step 5: Direct Transit. The driver travels to the destination via the quickest feasible route. Dispatch will monitor progress throughout the trip and will provide alternate routing if necessary due to road construction, closed roads, weather, etc. Clients will receive immediate notification of potential delays to their delivery schedules.

Step 6: Receiving and Signing off on Your Order. The receiving company signs for the order. The time of arrival and physical state of the order upon arrival will be documented.

Step 7: Delivery Confirmation. The sender receives both the proof of delivery and the associated documents (typically through email) in a relatively brief period of time after the package arrives at its intended location. The documentation can be used as evidence during an audit, a review of quality and/or an ongoing investigation.

What the STAT Premium Really Pays For

Every single step in that series has been created to avoid waiting. Also, each of those steps is dependent on the availability of a person, a vehicle, and a system prior to the time an individual calls. This ability to always be prepared, rather than the number of miles driven, is a significant portion of what a STAT premium pays for.

What Gets Sent STAT (And What Shouldn’t)

One of the most effective actions a decision maker can take is to clearly define what constitutes an emergency (STAT) situation. In the absence of such definition, cost increases are inevitable, and legitimate emergencies will be obscured by the general chaos.

Typical STAT candidates

• Samples being processed for urgent clinical use will provide a clinician with information to make decisions regarding the appropriate course of action for a patient.
• Blood products and related samples needed for transfusion or surgical planning.
• Transplant-related materials, where viability windows are extremely tight.
• Drugs that are time sensitive, and which a patient needs to be administered immediately, but cannot obtain at their own neighborhood pharmacy.
• Intraoperative or pathology specimens requiring rapid review.
• The critical equipment/supplies need to be replaced when you cannot complete a procedure because of missing items.

Typical routine candidates

• Standard daily lab pickups from physician offices.
• Medical records and administrative documents.
• Non-urgent supplies and restocking orders.
• Recurring pharmacy deliveries to long-term care facilities.
• Samples with long stability windows and next-day turnaround.

The gray zone

A middle ground exists between those two lists, which includes important, yet non-critical requests; or requests that may have been important, however, due to poor timing, they have become critical. Some examples of these types of requests are when a sample is collected prior to its cut-off time and then left behind, or when a hospital forgets to place an order for a shipment. It is these types of requests that create the excessive cost associated with STAT orders.

The solution to reducing STAT costs is not to refuse to provide STAT service. Rather, it is to develop an internal policy (ideally developed jointly with your courier) defining who has the authority to approve a STAT request, and under what conditions. At every collection point, a one-page “decision-making guide” will generally do more to lower costs than any negotiated rate.

The Fine Print Most Providers Bury

This is how we earn our money with this article. Most people find the following information to be the most frustrating, and much of it is either hidden in service agreements or was omitted from sales discussions.

“STAT” with no defined response time

Ask each provider: What is STAT defined as in our agreement? Are you saying we will pick up the item by this time? Or are you saying we will deliver the item by this time? Or is this just what you plan to do? If the contract has statements such as “as soon as possible” or “best efforts”, there are no guarantees. You are simply hoping that something will happen. Find measurable language.

Pickup time versus delivery time

A fast pick up and slow delivery will not provide benefit to the patient. You must know what clock is being used, and when that clock will stop.

Distance and zone limits

The STAT commitments made by many companies will only apply to the area in which they provide services. Response times for those outside of this area will be longer and/or an additional charge will be applied. If your company has sites located in either rural or suburban areas, determine the extent to which the commitment applies.

After-hours, weekend, and holiday rules

Are you really available 24 hours a day, 7 days a week, 365 days a year? Or is it more like business hours and then “after hours” availability? If so, will I pay more if I call during the evening? Will it take longer for me to receive help after 5 p.m.? Emergencies don’t happen just between 9:00 a.m. and 5:00 p.m., so why should your coverage?

Wait time charges

Wait times can cause unexpected billing issues. What are the time limits for drivers waiting on specimens? How much will those waits cost?

Surcharges and add-ons

After-hour fees, fuel surcharge, temperature controlled fee, special handling fee, etc. will make your base rate look completely different than what you thought it was going to be. Request a sample invoice of a STAT run in the past.

Capacity during peak demand

When there is a high demand for STAT services from multiple clients (e.g., severe weather events, large-scale emergencies), what do providers do? While providers rarely discuss how they will handle this type of event, this is precisely when your organization has the most critical need. Find out what measures the provider takes to ensure that its existing clients continue to receive uninterrupted service.

Subcontracting

Does the company employ, and provide training for, their own drivers? Or do they contract out over-flow work to a third party? There’s nothing inherently wrong with contracting out work; however, you should find out if the individuals who will be transporting your specimens have received the same level of training regarding compliance and handling procedures.

Liability and loss limits

What happens if a specimen gets lost, delayed, or damaged? Many agreements limit the provider’s liability for lost, delayed or damaged specimens to very small amounts that are totally unrelated to the clinical or financial value of the shipment. Be sure to read this part of the agreement thoroughly and consult with your company’s attorney or risk management team.

Compliance, Chain of Custody, and Temperature Control

Speed is only one part of being a good medical courier. The other part is delivering the package so that it remains intact, secure, and legally sound.

Chain of custody

Every time a person comes into contact with a specimen, the date/time of that contact, as well as the state of the specimen at the time of each transfer are documented. This documentation can be just as critical to the diagnostic, forensic, or clinical trial specimens as the specimen itself. STAT runs should be documented with greater discipline than routine runs, as the urgency of STAT runs may tempt individuals to omit certain documentation steps.

Temperature control

The provider should provide you with information about how they maintain the appropriate temperature of each sample (ambient, refrigerated, or frozen), during transit. You can also inquire about whether their vehicle is capable of providing a controlled environment. Additionally, ask them if they use validated containers and monitoring devices. Lastly, ask them if they will be able to supply you with a temperature record upon request.

Regulatory awareness

The medical courier industry is a regulated environment where there are both safety and privacy regulations that must be met. Most often, these regulations will require all drivers to complete Bloodborne Pathogen Training; all biological materials must be packaged and labeled properly; and all patient information must be kept confidential. Generally speaking, in the U.S., when a courier delivers Protected Health Information (PHI), he/she is required to adhere to the same privacy practices as outlined under the Health Insurance Portability and Accountability Act (HIPAA). When a courier delivers biological materials, he/she must also meet the packaging and handling requirements established by the Department of Transportation (DOT) and Occupational Safety and Health Administration (OSHA). It is important to have your compliance team identify exactly what regulations apply to your company and to ensure that your courier can provide documentation regarding the training and procedures they use.

Driver training

A driver who knows why they’re carrying a sample will treat the sample differently than a driver who views the sample as just a closed bag. Question the frequency of training on sample handling, spill clean up, patient confidentiality, emergency response, and the update of those trainings.

The Real Cost of Getting Tiers Wrong

Choosing the wrong service mix costs money in both directions.

Overusing STAT

When STAT becomes part of everyday practice, spending increases rapidly. Overuse of STAT for non-critical requests each month will create a large portion of your hospital’s budget, but will have little impact on improving patient care. In addition, the overuse of STAT can reduce the importance and urgency of the STAT runs which are actually required.

Underusing STAT

Organizations that attempt to conserve funds through using a route that has been established for routine specimen transportation will run the risk of having delays in receiving their test results, spoiling their samples, requiring multiple collection procedures, and delaying their patients’ treatments. When an organization must recollect a specimen, it causes inconvenience to the patient, duplicate laboratory testing, and loss of productivity for its employees. In some situations, the financial costs associated with the delay in obtaining a patient’s laboratory test result can be very high.

Hidden operational costs

Poor selection of service mixtures creates problems even if everything else is going fine: employees wasting time trying to find out where things were delivered, multiple telephone calls to customer service (dispatch) to check status of items, billing disputes due to unexpected charges, and strained relationships with those providing referrals while they wait for results.

The value of reliability

The best way to consider the price of courier service is not by the miles traveled, but by how many deliveries can be counted on. It may be less expensive to pay a little more for a reliable provider, rather than paying a lower price for a provider who constantly needs help fixing mistakes and escalating problems.

How to Choose the Right Service Mix for Your Organization

A successful service offering begins with understanding what customers want. To assist you in doing so, here’s a useful framework.

Step 1: Map your shipments

I list below what kind of shipment I use (e.g., standard, express), how often I ship (daily, weekly, monthly), the location I am shipping from (city, state, country), and the destination I am shipping to (city, state, country). I group these based upon the level of urgency, such as “immediate,” “same-day,” “next-day,” or “flexible.”

Step 2: Identify true STAT triggers

Work with your facility’s clinical and laboratory leadership to establish the circumstances that warrant STAT testing. Document these guidelines and make sure they are readily available to staff at each of your collection sites.

Step 3: Build a routine backbone

A well-designed routing system can efficiently handle the predictable amount of work you will have to complete. Clearly define when each route should be completed, and ensure all employees are aware of those definitions. When you establish a consistent routing program, you will reduce the number of emergency calls (STAT) that result from last minute requests for service.

Step 4: Add tiers in between

There are many other types of transportation services that fall between STAT and routine. Some examples of these are scheduled same day, rush, and on demand. They provide a cost-effective alternative to STAT, while providing faster delivery than routine. These types of delivery services may provide the right balance when your shipment is important but does not require immediate attention.

Step 5: Define authorization rules

Establish a process for determining who is eligible to receive STAT services, and establish the data requirements for those requests. This does not restrict care, but rather ensures the integrity of your priority system.

Step 6: Track and review

The performance of the delivery on time, how often STATs are used, what the cost is of each trip made, and why STATs are requested should all be measured. At least once a quarter, review this data with your courier. You’ll see patterns begin to develop: a location that consistently misses its cut-off time, a service that requires immediate attention (or “rush”), or a route that can be altered to make it more efficient.

Step 7: Plan for contingencies

Find out what will occur if the car is out of commission, the driver cannot make it, or road closures due to weather occur. A reliable provider should have other cars, drivers and different routes to take in case of an emergency, and be able to explain how they will use those options immediately.

How MSI Handles Critical Runs

Stat and routine medical courier services are different types of services. They are not merely different marketing names for the same service. Stat and routine medical courier services differ from each other with respect to how they are dispatched, how they are routed, who is assigned to each type of service, how they document each type of service, and how they hold themselves accountable for each type of service. Therefore, these differences impact what occurs when a specimen needs to be transported immediately.

Organizations that are able to benefit the most from their relationship with a courier company will have done three things right. First, they will know what each type of delivery includes. Second, they will set clear guidelines internally regarding when to use which type of delivery. Finally, they will select a courier company that provides all the relevant information and doesn’t try to hide any details.

Review the list of items above and compare the results of your assessment to the terms of your contract. For those who will be developing a new program, first map out your shipments and determine the conditions under which you will use STAT.

If you’re looking for a courier that considers each important delivery to be why you used a courier initially, then we’re here to assist you.

Ready to protect your time-critical deliveries? Set up STAT service with MSI today and put a dependable plan in place before you need it.