Tag Archives: laboratory innovation

“Less is more in the microbiology laboratory?”

The Art of Microbiology, , ,

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

“Storing up your compliments”

Confessions of a Microbiologist,

compliment-day-fun

For accreditation purposes, we are required to keep records of all the complaints we receive into the microbiology laboratory, but not the compliments…

Every so often, someone will give you, or the laboratory, a pat on the back for a piece of good work you have done. This compliment can of course be verbal, by email or by letter.

I would advise you to store the compliments for a rainy/stormy day…

Not only does it balance out the complaints, but I think it is actually very important.

If you are innovating, making changes, and pushing the boundaries of the laboratory practice of microbiology, you can be sure someone will have a real go at you at some point in time. It is completely inevitable. That is when it is nice to have a ‘compliment box’, to objectively demonstrate that not everyone has the same opinion of you/your laboratory as your complainant.

So sitting beside my “Complaints” folder in Microsoft Outlook, I also have a “Compliments” folder, ready to be dug into whenever it is required. Admittedly my Compliments folder is not as big as my Complaints folder! Actually I don’t mind this at all. If the compliments I received were more numerous than the complaints, I would be worried that I was not being innovative enough and simply concerned with trying to keep everybody happy…

Michael

“Operators, Troubleshooters and Innovators”

Confessions of a Microbiologist,

All laboratory staff need to be Operators, in that we all need to be able to follow (sensibly) the method manuals, the guidelines and the safety regulations etc, etc. An operator can generally function with basic levels of training and knowledge, as long as nothing goes wrong…. 

In addition it is desirable to be a Troubleshooter. Even when the guidelines are followed, things can still go wrong, and do. A Troubleshooter is able to identify the problem and put procedures in place to rectify it. A Troubleshooter needs to have a good in-depth knowledge of their area and also the confidence to fix things when they are not working.

Most valuable of all is to have Innovators within the laboratory, staff who don’t just follow the guidelines, but are able to suggest changes to them in order to provide a better outcome. Innovators require not only knowledge and confidence, they also have the passion and the will to dream up the ideas and to suggest the changes.

The more troubleshooters and innovators the laboratory has, the better.

Best of all is when the troubleshooters and innovators are not the most senior people in the lab, but the most junior. That makes for a really dynamic lab…..

Michael

P.s. I have added some MCQs on laboratory testing of Varicella Zoster Virus (VZV) to the website.