I’ve been asked more than a few times in the last dozen or so years to outsource microbiology. It saves money, doesn’t affect turnaround time, and improves quality. Duh! is implied.
Really? I wonder.
Saving money. Whenever administration talks about saving money, it’s usually hard green paid up front. If it isn’t a new test bringing in big bucks for reduced cost, it’s difficult to sell soft dollars associated with reduced length of stay, faster treatment, switching to correct antibiotics sooner, coupling antibiotic use with nutritional assessment, etc. These clinical concerns are valid but it’s like Miss Othmar in the Charlie Brown cartoons; it sounds like a noisy trombone to Linus the bean counter. By contrast, cost per test A vs. reference lab fee B along with cutting payroll is Schroeder’s piano.
I’m a fan of soft green: experienced techs monitoring collection of specimens, talking to the physicians during culture workups, and putting results in their hands so patients can be treated, go home sooner, and come back less often. But good luck proving that saves money!
Turnaround time. There is a perception that because the bugs have to be cultured, turnaround time isn’t important. After all, in the meantime the patient is treated. But for most small rural hospitals, a once-a-day courier is the norm. Culture workups are delayed by at least a few hours. The soft green argument applies. But this is just an excuse to prioritize cost.
Improved quality. The prejudice that “bigger is better” runs deep. Whatever the test, the reference lab or medical center does it faster, cheaper, and with the best technology and smartest people. I hear it often. A physician once called our lab to complain that our Vitek had not reported specific antibiotics that were not indicated according to FDA guidelines. He said, “I can’t believe your laboratory is so far behind the times!” Another physician complained that we didn’t do a D test that was “the state of the art at big labs.” This is an old canard that again prioritizes cost.
Keeping micro can be difficult. Next, I’ll consider how.
NEXT: Keeping Micro