Increasingly common throughout the country in the last two decades, merging hospitals and health systems have enabled growth in laboratory diagnostics volumes, which in turn have enabled many laboratories to adopt technologies that prior volumes could not easily justify. As this trend continues to grow, many clinical laboratories have had to adapt to providing services to facilities outside of their immediate practice area. Given the wide-ranging impact of the COVID-19 pandemic on laboratory service, few departments were more affected by this trend than microbiology.
As this overall trend is indeed likely to continue, most laboratories are keeping a keen eye out for ways to offer broader and more advanced microbiology services, and benchmarking and technology and automation acquisitions go hand in hand with these goals.
Take Advantage of Advanced Platforms
Generally speaking, microbiology laboratories perform all operations related to bacteriology, parasitology, mycobacteriology, and mycology processes, among others. Many also have begun to incorporate a molecular test menu related to microbiology workflow, but with its own special requirements. Of particular benefited, modern molecular platforms allow for the detection of resistance markers in positive blood cultures. This helps decrease TATs to properly administer appropriate antibiotics for treatment of sepsis.
Relatively recent advancements in automating several aspects of clinical microbiology workflow have certainly benefited micro labs of all types and sizes. There are now multiple instruments that can work in concert to process microbiology workloads quickly and efficiently. Examples of these instruments and platform types include:
Consider Your Catalysts for Change
One of the many catalysts for improving microbiology specimen management involves the receipt of specimens in the wrong container or with incorrect or incomplete order information from the operating rooms (OR). As with most process improvement strategies that seek to address challenges that affect multiple practice areas, meeting with representatives from all relevant practice areas is a logical first step in overcoming these challenges. Thus, this scenario may necessitate process review meetings with OR nurse educators to discuss the workflow of specimen handling and transport. As can be the case when two different departments collaborate on a single process without prior review, there may be discrepancies or incorrect information in how the process should be performed that negatively affect both practice areas.
In the case of specimens coming from the OR, nurses, scrub techs, and surgeons may not have current and easily accessible resources to place microbiology orders efficiently and accurately, consistently obtain appropriate specimen labels, or ensure the use of appropriate containers. To ameliorate these challenges, the micro lab can help itself by seeking to reduce the anxiety of processing microbiology specimens for OR nurses and scrub techs, and thereby reduce the amount of re-work required in the microbiology lab (and the OR) when specimens are handled incorrectly.
All clinical disciplines are aware of the importance of collecting, handling, and managing appropriate specimens the first time, and methods of doing so have a beneficial impact on patient outcomes and patient care.
Increased Volume Favors Automation
Given that microbiology continues to depend on skilled technologists, taking advantage of automation or standardization in any operational aspect can be of benefit, as these capabilities allow techs to focus on tasks that best suit their skillsets. Furthermore, the process of evolving from a small number of tests to a large number begins to take automation for granted, and this is an area that microbiology can particularly benefit from.
For example, an automated preanalytical specimen processor can automatically plate incoming specimens; a process that would be untenable with a large sample load under a fully manual system. It is inconceivable to imagine manually plating a large volume of microbiology specimens once a critical mass has been attained. Further, automation allows micro labs to screen plates faster and utilize offline incubators to ensure that additional increases in sample volume will not necessarily require more technologist interaction.
Looking forward, microbiology automation is beginning to incorporate certain artificial intelligence (AI) that applies algorithms to identify negative samples, which can then be pooled and reported out, enabling review of only positive samples. Another advancement involves the use of chromogenic culture media in an automated processor, which are used for throat, MRSA, Candida auris, and vancomycin-resistant Enterococcus (VRE) cultures. In this case, an algorithm looks for color changes in bacteria to inform the tech of a presumptive positive for Group A Streptococcus, for example, based on automated ID. The negatives can be discarded, giving the techs a head start on the presumptive positives.
Look to the following data related to microbiology platform use and acquisition plans. Incorporating these data into your own instrumentation proposals can help benchmark your microbiology operations, assist in streamlining workflow, and improve overall operations in your laboratory.
David McCormick is a managing editor at Ridgewood Medical Media, publisher of Pharmacy Purchasing & Products and MedicalLab Management. He can be reached at email@example.com
Satisfaction with microbiology platforms continues to grow. This technology enjoys particularly strong ratings, with 9 out 10 facilities assigning top marks to their platforms.