There are upsides and downsides of every laboratory, and the last laboratory I worked in had many many strong points. However one of the major advantages of my current job compared to my last one is the fact that the microbiology laboratory is inside the hospital. I am now on the same corridor as the ITU and the Infection Control Nurses, and a stone’s throw from the acute receiving ward and most of the other wards.
It is a big plus for me that I am easily able to see patients again, and speak to clinicians face to face. This also helps in building the trust that is required for effective laboratory/clinical relationships.
I think it is also helpful for microbiology scientists/technicians when the patients from whom they are processing clinical samples are on are on the wards surrounding the laboratory, not in a separate building or a separate area of town. Having an in-hospital lab makes it real, focuses the mind, and strengthens the resolve to do your best for the patient.
Although laboratory tests can essentially be done anywhere, my current job is now reinforcing for me the importance of having a laboratory that sits within the hospital, and preferably in the main building. For me this is going to be a pre-requisite for any future job.
I have had some experience whilst working in New Zealand of Microbiology Laboratories that are too small. There are inherent difficulties in operating small microbiology laboratories.
- Seeing enough of each sample type to maintain quality and expertise.
- Reduced exposure to unusual organisms and resistance patterns.
- Covering staff rosters, annual and sick leave etc.
- Maintaining External QC.
- Using kits before their expiry dates.
- Cost per sample is increased.
There is no exact figure as to when a microbiology (Bacteriology) lab is too small to maintain quality, but I personally think some of the problems above start to arise when the sample volume is below about 50,000 per year. This is very much a ballpark figure.
But can a microbiology lab be too large?
Laboratories in general are getting larger all the time. The new multi-line track biochemistry analysers that are now coming in can literally analyse 1000s of samples a day, catering to a general population of well over a million. The limiting factor is getting the sample to the lab, and a transport time that is tolerable to the clinicians and the patients.
With Total Laboratory Automation on the horizon for microbiology, we are going to start seeing increased processing capacities for bacteriology labs, with the ability to process 1000s of samples a day.
However what are the downsides of such progress?
When thousands of samples are going through a laboratory there are a few potential disadvantages:
- It may lead to lack of personal knowledge of particular patients of interest.
- If the (automated) system breaks down for whatever reason then it may be difficult to transfer samples to a lab close by or to process the same number of samples manually.
- The laboratory service may become less personal and relationships between lab staff and clinicians may become more detached.
While automation within microbiology laboratories should be embraced (not least because it is completely inevitable), efforts should also be made to counteract the potential difficulties as above. So how big is too big? Again this is a difficult question, but I suspect that once a microbiology (bacteriology) laboratory starts processing over a million samples a year then the factors above will start to become prominent.
It is important that in the transition to Total Lab Automation, a process which most microbiology labs will undergo over the next 5-20 years, our microbiology laboratories remain laboratories, and do not become factories….
Different microbiology laboratories often have different ways of doing things, even when under the same company or management board. There are often good reasons for these differences.
I would regard valid reasons for differences in laboratory systems falling into the following categories:
• Local disease epidemiology
• Local antimicrobial resistance patterns
• Financial reasons
• Logistical reasons
• Cultural reasons
Another reason for differences between laboratory systems are dictats from higher or corporate management levels. This may not always be welcome as the control here is somewhat outwith the laboratory itself.
Then there are the not so valid reasons for laboratory differences, which unfortunately occur all too frequently. These are:
• “Personal preference”
• “This is the way it has always been done here in this lab…”
As I work in different laboratories over the next few months, it will be interesting to see what the process differences are between laboratories that are supposedly closely linked. Where differences exist, I will try and assess whether they are justified or whether the “Ego” or “Institutionalisation” has created them.