I am by nature quite a lazy person. Don’t get me wrong, I am not afraid of working hard at times, but I am always on the lookout for ways in which I can optimise the productivity and the quality of the laboratory, whilst creating time and resource for other opportunities.
Time and effort are terrible performance metrics…
Aside from efficiencies, can doing less work in the microbiology laboratory actually lead to better patient outcomes? We know that our ultimate aim is to improve patient management. Are there circumstances where in our enthusiasm to optimise patient care, we might actually do the opposite?
Here are some examples where doing less work in the microbiology lab might actually be beneficial to patient care:
Minimising work up on probable contaminants – If coagulase negative staphylococci isolated from blood cultures are routinely reported with susceptibility profiles without any supporting clinical information that they might actually be significant, this will lead to unnecessary antibiotic use with the potential for adverse effects, along with the potential for delayed patient discharge.
Avoiding tests with low clinical utility – Sputum cultures in the community setting are rarely useful, and the results may lead to undertreatment, overtreatment or simply the wrong treatment.
Reducing unnecessary microbiology tests– Rejecting urine cultures from patients where there is no evidence of UTI symptoms on the request form prevents unnecessary treatment of these patients with antibiotics.
Not processing duplicate specimens – Rejecting repeat samples (e.g. urine, sputum, stool) submitted on the same day from the one patient means that conflicting results are avoided.
Avoiding overuse of broad-range multiplex PCR panels – Running a full respiratory viral panel for a simple upper respiratory tract infection may end up delaying patient discharge from hospital. More targeted testing is often better.
Following proper sample collection and rejection criteria – Rejecting poorly collected specimens (e.g., saliva instead of sputum for pneumonia testing) avoids misleading results and unnecessary treatments.
Optimised result reporting – For example, reporting Group C/G beta-haemolytic streptococci from throat swabs in patients with acute pharyngitis may lead to unnecessary antibiotic prescribing. Along the same lines, testing and reporting unnecessarily broad antibiotics when performing susceptibility testing can lead to unnecessarily broad antibiotic coverage with concomitant side-effects on the patient and selection of antibiotic resistant bacteria.
As demonstrated above, there are lots of ways in which doing less work in the microbiology lab is not only cost-efficient, but it can also improve the overall management of the patient.
As the range of different assays we are able to offer in the microbiology lab continues to increase, we need to constantly review our current test repertoire and whether it is providing significant value to the clinicians, and ultimately the patient.
Less is often more when it comes to the microbiology laboratory.
Michael
