The great things about a small hospital are exactly why it is important to keep micro: a close connection over time with individuals in the community, a good working relationship with a small group of doctors, and a limited number of nurses to educate in the importance of collection and labeling issues. Even so, keeping micro can be difficult.
Once bean counters start scrutinizing hard dollars, it can seem simple to weigh “make here” vs. “buy elsewhere” arguments for tests not performed STAT. That includes much of clinical microbiology.
Advantages to keeping micro include: high recovery rate of microorganisms, reduced turnaround time, better communication between the lab and physician, making a local antibiogram, and better infection control, as pointed out in one journal. The impact of rapid and direct communication between the tech reading the Gram stain or looking at the plates and the physician making treatment decisions is invaluable. Unfortunately for laboratories, this value is measured in soft dollars: reduced length of stay, better wound care, and other team-related success.
Thus, a two-step approach can help keep micro in house:
Training. The more techs that perform microbiology testing, the better. More techs means better flexibility on weekends, schedule redundancy, more active discussion on quality issues in a group setting, and better recovery after someone leaves.
Communication. Talk face to face, early, and often with caregivers about microbiology issues. This includes nurses, pharmacists, infection control practitioners, and physicians. It means reviewing chart history, antibiotics, and orders. The more your techs know about how and why cultures are being collected and acted on, the better.
The laboratory has to initiate these changes. We won’t be asked.
At our hospital we make daily rounds of inpatient and ED areas, looking at charts to focus on microbiology, including blood and other cultures. If a culture needs recollection, we speak directly to the nurse. We let physicians know face to face what early results show. The harder we can make those soft dollars by being a visible, indispensable part of the process the better. It’s better patient care, too.
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