CEO SUMMARY: Two projects to boost the performance of the microbiology laboratory at University Health Services in Augusta, Ga., significantly reduced test turnaround times in ways that contributed to improved patient outcomes. The first project was in 2016, when the lab introduced mass spectrometry and MALDI-TOF for bacterial infections, cutting turnaround times from 104 to 74 hours. Last year, a new antimicrobial-testing system cut TAT by an average of 42 hours.
New diagnostic technologies and automated systems are helping microbiology labs to cut test turnaround times and improve patient care.
The experience of the microbiology lab team at UH Lab, the for-profit lab company of University Health Services (UHS) in Augusta, Ga., is a prime example. Since 2016, the microbiology team has combined Lean management methods with new microbiology tests and systems. These innovations have contributed to improved patient care, substantially reduced test turnaround times, and helped increase the productivity of the microbiology lab staff.
In the first of two initiatives, the lab introduced mass spectrometry and MALDI-TOF to cut turnaround times for these tests from an average of 104 hours to 74 hours. In the second project, the lab introduced a test system that the FDA had cleared for clinical use just weeks earlier. Using this test allowed the lab to drive down TAT by an average of 42 hours and by more than 50 hours for some bloodstream infections, said Christa Pardue, MBA, MT(AMT), Laboratory Director at University Health Services.
In addition to these positive outcomes, local news teams made University Health Services and UH Lab the centerpiece of stories about how the latest innovation would benefit patients by improving the diagnosis and treatment of bloodstream infections. After reading these stories, patients took the unusual step of calling the lab to ask if such testing would be available to them and their family members.
Successful Lab Outcomes
In a lab case study that Pardue presented at the THE DARK REPORT’S Lab Quality Confab in October in New Orleans, the lab director explained how the lab took steps starting in 2016 to improve workflow efficiency in the micro lab. Founded in 1818, the nonprofit hospital is the second oldest in Georgia. It has three acute-care facilities, 831 licensed inpatient beds, and serves patients in 25 counties in what Georgians call the Central Savannah River Area.
The University Hospital Laboratory, known as UH Lab, is a for-profit private reference lab that holds about 60% of the local market share. “We gained that market share through our customer service and turnaround time,” Pardue said. “In September, UH Lab absorbed a local reference lab, which doubled our pathology volume overnight and brought in additional microbiology and core-lab testing. This lab chose to merge with us because of the customer support that we provide.”
UH Lab’s clients include several critical access hospitals, a long-term acute care facility, and a rehabilitation center. “All of these places refer those patients who need a higher level of acute care to the University Hospital, and some admit our bundled-payment patients as well,” she said. “These patients have the potential to be our outcomes.
Fully-Inclusive Micro Service
“We consider these facilities as key clients,” noted Pardue. “Our lab strategy is to offer a fully-inclusive microbiology service and interact daily with their infection prevention departments. That gives us a chance to sustain the local level of antibiotic resistance within our community.”
Two years ago, Pardue saw the need to reconfigure its microbiology workflow. “We’ve always had an excellent microbiology lab, but in January 2016 we began to bump up against some capacity and near-future staffing constraints,” she explained. “Our more senior staff began expressing concerns about our ability to absorb additional volume. And, we were approaching the point where more than half of the microbiology staff were eligible to retire.
“We recognized that more automation and improved workflow were the only ways to prepare for the imminent retirement and transition to new-grad staffing,” she added. “Our Lean studies of work processes revealed that our existing instrumentation was driving a hands-on, off-line workflow.
“For bacterial infections, we used a chemical methodology and some bench testing,” stated Pardue. “We also had a batch process for microbiology that was not effective. For example, we plated out of positive blood culture bottles.”
Ineffective Batch Processing
In May 2016, UH Lab introduced mass spectrometry and MALDI-TOF for bacterial infections. “We also reduced batch sizes to give us a less time-consuming workflow and started multiple-plate reading benches,” she said. “These steps reduced our turnaround time by 30 hours—from 104 to 74 hours. In so doing, the staff felt relief because of the changes the new workflow brought to their day.
“The new workflow still required experienced staff but less effort,” she added, “and so plate reading for infectious disease and microbiology are still done on the day shift only, but we’ve had no more complaints about workload from our staff.
“While we had a faster process and reduced turnaround times, our equipment still required an experienced plate reader, meaning we had not addressed our staffing concerns,” Pardue explained. “As long as we needed an isolate, we had to have experienced microbiology techs.”
Rapid Pathogen ID
Last year, Pardue learned of the recently FDA-cleared PhenoTest BC Kit from Accelerate Diagnostics, in Tucson, Ariz. “This system would provide rapid pathogen identification and sensitivity to antibiotics straight from a positive blood culture bottle,” she said. Seeking to get other lab workers involved in the decision, she asked staff about it. “They were a bit pessimistic that it could do what it said it could do, but if it could, they wanted it,” she commented.
Next, she presented the idea to the Laboratory Utilization Committee (LUC), a medical staff-level committee that the chief medical officer chairs. The LUC includes the chiefs of hospital intensivists, infectious disease, and pathology; and representatives of radiology, pharmacy, and performance improvement. “The LUC’s role is to establish an effective and efficient testing formulary,” Pardue said.
Preparing for the New Test
Over six months, the laboratory utilization committee analyzed the test. It reviewed such metrics as turnaround time, cost per inpatient stay, sepsis read-mission rates, and costs per antibiotic day. Following this review, the LUC agreed with lab staff that Accelerate Diagnostics’ performance verification program would allow hands-on review. The result of the LUC’s analysis and the patient verification program (PVP) allowed UH Lab to assess how the test would work in real-time. Less than a year later, UH Lab went live with the test.
There is another interesting aspect to this story. As one of the first labs in the nation to begin using the new test after it gained clearance from the FDA, the news media gave this event wide coverage. These news stories triggered patient calls into the lab, according to Pardue. “The coolest part of this day was when patients’ families started calling me, asking, ‘Are we going to be able to use this new technology on our family members?’ These are the calls you want your lab to get,” she said.
Utilization Committee Helps UH Micro Lab Analyze New Diagnostic Test Over Six Months
WHILE THE LAB AT UNIVERSITY HEALTH SERVICES was evaluating Accelerate Diagnostics’ PhenoTest BC Kit for inclusion on its test menu, the test developer suggested UH Lab participate in its performance verification program (PVP).
“The PVP would allow us to install the system and gain experience with it while the test awaited FDA clearance,” explained Christa Pardue, MBA, MT(AMT), UHS Laboratory Director. “That way, we could gather data on what the test could actually do, and we could do our CLSI validation early.
“We established an implementation team and trained our staff in two days because it’s an easy test to run,” she said. “You just put 500 microliters in a vial, pop the vial in the kit, and pop the kit in the instrument.
“We also did performance studies, including a manufactured blood product inoculated with a known pathogen,” she added. “Of course, we monitored the kit’s actual turnaround times.
“These assessments showed us how we could use this new test to engineer a streamlined workflow that would be–on average–about 42 hours faster than the 74 hours we had on the mass spec system,” she said. “While 42 hours was the average, we did MRSA testing 50 hours faster, andklebsiella and e. coli testing each were completed 54 hours sooner. Cutting the turnaround time came mostly because we didn’t need to plate out positive blood cultures.
“Our validation outcomes were very good. Sensitivity and specificity were great,” she commented. “We predicted that the accelerated panel would cover 91% of the pathogens seen in our lab. In actual use, it covered 97% of the pathogens that we’ve had in our lab.
“The Laboratory Utilization Committee determined the analysis to be a success because we had great sensitivity and specificity, and it showed that, for blood infection testing, we could reduce our turnaround time by 42 hours. That is almost two days sooner than what was typical with MALDI-TOF,” she concluded.
Contact Christa Pardue at 706-774-5401 or firstname.lastname@example.org.