Tag Archives: sample quality

“We’ll see what we can do…”

The Art of Microbiology, , ,

You might be familiar with the following phone calls to the microbiology laboratory:

  • “I know you only have 0.1ml of CSF left at the lab. Can you still do a viral CSF panel for me?”
  • “Although (I swear) the blood culture was from Mr X, the bottles were accidentally labelled as Mrs Y. Can you still process it?”
  • “The patient is currently on erythromycin for a chest infection. Please can you test the E. coli in the patient’s urine against this antibiotic?”
  • “Regarding that stool sample that we sent to the laboratory five days ago. Can we now check it for C. difficile toxin?”
  • “My patient has a mixed growth in her urine. Can you check to see if everything that you have grown is susceptible to augmentin?”
  • “Sorry I sent the B. pertussis PCR swab in the wrong transport media. Would you process it nevertheless?”

We’ll see what we can do….

We often get requests to do something in the laboratory which is either simply inappropriate or has a good chance of producing a sub-optimal result. This might be because of inadequate sample volume, transport delays, labelling errors, wrong sample type, etc. etc.  Because we want to be nice, because we want to keep everybody happy, we often pander to such requests. However by doing so we compromise the quality standards in the laboratory, with potential harm to that all important end user, the patient.

And we also set a precedent for further such requests…

The staff working in the microbiology laboratory are the key gatekeepers of a high quality service. If a sample or test is unacceptable for whatever reason, they should have the authority to reject/refuse it, and this authority should be backed up to the hilt by lab managers and pathologists.

It is only by doing this consistently that high quality standards become the norm within the department. And what’s more, laboratory users soon learn that future requests of a similar nature will be futile. With time, laboratory users will increasingly understand why you take this approach.

So instead of saying “We’ll see what we can do,” we should be replying “Sorry we are unable to do this.” to such requests.

Occasionally this might provoke a grumble or even a complaint. I have had my fair share!, but trust me, such complaints are completely ungrounded and never go very far. If you don’t receive the odd “complaint” from time to time, you probably aren’t doing your job properly.

When it comes to test quality, ensure your microbiology laboratory is both strict and consistent in its messages, and the respect will come…

Michael

 

“Tough Love”

The Art of Microbiology,

Disease X is diagnosed by using a PCR on a nasopharyngeal swab which has a sensitivity of 90%. However disease X can also be diagnosed by using a throat swab but with a lower sensitivity of 70%.

Do you accept the throat swab for testing?

Many laboratories do…

However by doing so I think we are accepting second best, regardless of how the result is reported, or what disclaimers are added.

By rejecting such a throat swab and asking for a nasopharyngeal swab (or whatever the optimal sample might be), the requestor/s quickly learns what swabs should be taken. It does not take long for the laboratory to start getting the correct samples consistently, and as a consequence, give out the best results.

Regardless of which microbiology discipline you are talking about, when you accept samples that are second best, you can be sure that you will continue to receive them. The difference in sensitivity/specificity is often not appreciated by the requestor, even if it is documented on the report.

Of course you might get a grumpy phone call from an annoyed clinician asking why their patient’s swab was not processed when it was sent to the laboratory, but the ensuing empathy and explanation that is required are all part and parcel of the job. (and water off a duck’s back for me!)

If you want to have a really high quality laboratory, producing really high quality results, then you need to be really strict with what is acceptable for testing…

Tough love.

Michael