Building the CDC in your community

I am not referring here to the Centre for Disease Control, which is a great resource which I use often to look up things I should know anyway, but don’t.

I am referring to the acronym “Clinical Details Culture”, an equally important CDC in my mind.

At the laboratory I work in, we have just implemented a mandatory clinical details policy for all microbiology samples. The only exceptions are those “difficult to obtain” samples taken from sterile site areas. For everything else, if there are no clinical details supporting the testing, then no testing is performed by the laboratory.

Now when I sign out a list of microbiology results I have clinical details on each and every request form. This is wonderful! In a good percentage of cases it changes both the testing and reporting of results. In other words the quality of results being produced has improved. And no longer will I get staff complaining to me that there are no clinical details on forms!

This has not been an easy policy to implement. Even after several months of preparation, there have been a few (almost inevitable) teething  problems which have had to be worked through. One key area is ensuring that all the staff members assess the clinical details provided in a consistent and standardised fashion. This has involved a lot of protocol development and these protocols are still in a process of evolution. For example “Erythema and increased pain leg ulcer” are acceptable details whilst “chronic leg wound” is not, and then there is the myriad of word variations in between. It is not straightforward!

Although most of the clinicians have been supportive of such a policy and indeed have embraced it by including excellent clinical details, there remains a small cohort who refuse to believe that the inclusion of clinical details on microbiology request forms is important. There are a few others that believe in the policy in principle but have concerns over the logistics.

The goal over the next year or so will be to continue to build a clinical details culture amongst clinicians so that clinical information on microbiology forms (and all laboratory request forms) is the expected norm. This represents a positive step for all the involved stakeholders; clinicians, laboratory staff and patients alike.

Along the same lines I hope that many other diagnostic microbiology laboratories both nationally and internationally adopt a similar stance. The presence of clinical details is a key element of effective diagnostic stewardship. Without them, you are already on a hiding to nothing…



2 thoughts on “Building the CDC in your community

  1. Thank you Dr Micheal for a wonderful suggestions which is need of the hour I am sending a write up of self for benefit of many in the health care
    FILLING OF REQUESTS FOR DIAGNOSTIC MICROBIOLOGY The world of laboratory science remains poor as far the collection of specimens and diagnostic requests sent to the Microbiology, Never forget once a request is filled it becomes a legal document with legal validity higher the hospitals more complex the matters, it was my past experience in the at India’s flourishing corporate hospital in Chennai , no day goes without conflicts as there is no uniformity in filing laboratory requests and more than 40% do not contain the clinical information needed to process the clinical samples arising out of infectious diseases , however it much bigger with expansion of Medical colleges, and least importance is given in training the post graduates, in the affluent era of privatization one senior professor interacted with me even the post graduates entrust the specimen collection to junior nursing students ward boys to collect the specimens in infectious diseases, a great tragedy to the development of effective laboratory services , coming to the positive side of life, still we can find ways to improve the specialty as we live with good and bad of the specialty, I wish to deal with specimen submission the request form is the great communicator of clinicians and Microbiologists Request Forms Use individual requisition forms available from the laboratory or from our test requisition page. All test requests require a physician’s written order to process a specimen. Follow the collection instructions for each type of specimen. It is an area of conflict it is certain that the people working on the bed side mush collect the specimens and should be promptly transported to laboratory, however the Clinical Microbiologist can guide the health care workers on collection of critical specimens as in CT guided aspiration and issues related to Anaerobic cultures
    Patient Identification
    Most important criteria is patients from whom clinical specimens are obtained must be positively identified, utilizing at least two unique identifiers prior to specimen collection. Positive identification is the responsibility of the person collecting the sample. And must sign to bring the accountability
    Required Information
    All specimens must be labelled.
    Patient’s full name (not a nickname)
    Medical Record Number or other unique identifier (ID)
    Date and, if appropriate, time when specimen was obtained
    Specimen source
    Does the patient receiving the Antibiotics in the present and past
    Signature/ initials of collector
    The label should be affixed directly to the specimen container and not the bag
    Place the labelled specimen in the provided leak proof sealed plastic biohazard bag
    Place the matching requisition in the outside pouch of the bag
    The primary reason for rejection includes – specimens will not be accepted if the information on the specimen label does not match the information on the accompanying requisition.
    In case clinical puzzles a direct communication is more beneficial providing additional relevant information may be important in alerting the laboratory of the need for special handling or specimen work-up.
    Next question comes how reliable our results it all depends on many matters the responsibility should be shared between the Clinician and Microbiologist the reliability and value of test results depends on numerous factors. Improper collection, transport, or processing of a specimen can decrease the quality of patient care or result in unnecessary additional testing or treatment.
    Most of our Hospital have no policy it is certain it is too difficult in a complex world where even the qualified have least scientific spirit the physician will be notified of the reason for the specimen rejection. The specimen will be held in the Clinical Microbiology Laboratory, for 24 hours before being discarded. Action must be taken by the physician’s office staff or nursing staff after notification to properly resolve the rejection problem.
    Scientific basis of Specimen Rejection
    Inappropriate storage or excessive delays in transport of the specimen may result in the specimen being rejected for culture
    Inadequate sample (QNS)
    Specimen container contaminated or leaking
    Poor quality sample: Sputum samples are screened for evidence of Oropharyngeal contamination and will be rejected if failing to pass the screen.
    Poor quality sample: Sputum’s are screened for evidence of Oropharyngeal contamination and will be rejected if failing to pass the screen.
    WISH TO LEARN MORE Visit the following Reference.
    Ref Stanford Health care specimen collection Microbiology
    Dr.T.V.Rao MD Professor of Microbiology Freelance writer

  2. whenever someday all the patients can question the doc “did you fill my CD in request form?”, i do reckon all the DOC would change their CDC forever. So let’s send this reminder flyers to all the collection centres today. :O)

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