Tag Archives: weekend microbiology

“Something for the weekend?”

I know it is difficult to believe, but patients tend to be just as sick on Saturday and Sunday as they are from Monday to Friday.

I am not sure if the concept of the “weekend” is secondary to religion or the industrial revolution. Regardless of its origins, in healthcare facilities throughout the world, the clinical service that is provided at the end of the week is reduced somewhat. Weekends are good for society, but not so good for patients…

And the weekend is not always just two days. Add on a Public Holiday Monday and the weekend can stretch to three days. Over Christmas, New Year and Easter, the “weekend” is often four days. Four days is a long time if you are sick.

In clinical microbiology laboratories everywhere, molecular testing traditionally never happened at the weekend. The molecular department happily shut up shop on Friday afternoon, and re-opened again on Monday morning. In times gone by, this was due to the rather specialised nature of the testing, and also the relatively slow turnaround times.

Take the following hypothetical scenario, which you may be familiar with…

It is the evening before the Christmas break. A cerebrospinal fluid (CSF) sample comes in to the microbiology laboratory from a patient in ICU with meningoencephalitis. A viral PCR panel is requested to try and ascertain the cause of the patient’s symptoms. However because it is the weekend coming up, followed by two public holidays, it will be 5 (long) days before the PCR is performed.

A viral CSF PCR result can have the following positive effects on patient management:

  • A negative (HSV) result can allow empirical therapies such as acyclovir to be discontinued, or in the case of a positive result, the dose to be optimised.
  • A positive result can prevent further investigations, such as MRI scanning, and  other “exotic” laboratory tests being carried out on the CSF.
  • Can expedite discharge, when diagnosis is known.

The long weekend progresses, and the microbiology department continues to analyse significant volumes of relatively low value specimens. e.g. ear swabs, peri-anal abscess swabs, vaginal swabs, swabs from leg ulcers etc, etc. Yet sitting there patiently in the fridge is that CSF, probably the most important sample in the laboratory, and the one which could have the most immediate and profound effect on patient management. It looks on enviously at all the attention the other samples in the laboratory are getting!

This model doesn’t really cut the mustard anymore… We need to utilise the new (user friendly and rapid turnaround) molecular platforms (Cepheid Genexpert, BD Max as examples), so that we can offer a laboratory service at the weekend which has a genuine clinical impact.

Things are changing however. Molecular testing is slowly being introduced at the weekend in many microbiology laboratories. C. difficile testing and Influenza/RSV PCR are a couple of examples. But this progress takes time, and sometimes it takes more time than it should do.

We need to “disrupt” traditional weekend work at the clinical microbiology laboratory… On the weekend, put those ear and vaginal swabs back in the fridge, and find a way (somehow) to take the CSF out!

Michael

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“Something for the weekend”

Molecular testing in the clinical microbiology department has traditionally been performed Monday to Friday 9-5pm. There are various reasons for this. Twenty years ago, this  area was highly specialised hands on work. Turnaround times were long and the results often did not effect an immediate change in patient management.

Times are changing…

Nowadays molecular tests for bacteria and viruses can be performed in real time, with results that can dramatically change the patient’s management. The tests are becoming automated and simplified to the extent that they can often be performed by scientists who are not molecular experts. The newer molecular platforms, being completely enclosed, are “coming out” into the main laboratory, and the whole discipline is becoming more mainstream.

In light of this we need to start thinking of providing “molecular services” not just from Monday to Friday, but during the weekends as well, and overnight when necessary.

The laboratories that succeed in making this sort of progressive change, will be seen as giving the best service to their patients, and will be the laboratories that are still around in twenty years time….

Michael

It is not the most intellectual of the species that survives; it is not the strongest that survives; but the species that survives is the one that is able to adapt to and to adjust best to the changing environment in which it finds itself”