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How we slashed QC costs in microbiology.

Centralized quality control, along with shared monitoring

functions, helped 16 laboratories reduce spending on QC for identification kits.

Our problem was not unique. We wanted to continue performing quality control on microbial identification kits effectively and satisfy inspection agencies, yet drive labor and supply costs down to a bare minimum.

While this dilemma is common at many laboratories, the structure of our laboratory group made it especially challenging. On a contract basis, we oversaw three hospital and 13 outpatient laboratories within a 30-mile radius of Tacoma, Each had different microbiology workloads, and all required comprehensive quality control records.

The three hospital labs, Lakewood Hospital, Good Samaritan Hospital, and Puget Sound Hospital are staffed with technologists who perform identification and susceptibility testing. Outpatient laboratories plate cultures for delivery to a central facility for complete workup. Courier services routinely travel between all labs several times daily for specimen pickup and report delivery.

With such operational diversity, total costs for microbiology quality control of identification kits ran higher than we liked. The problem was magnified by the number of organisms required to test all positive reactions with any single kit. We were bogged down in paperwork and expense.

A microbiology committee composed of hospital and outpatient laboratory representatives drew a bead on these costs. It developed a program that trimmed our annual quality control spending by 75 per cent and eliminated countless hours of duplicated technologist time.

Probably the most important decision of the committee was to evenly spread the work and cost of performing complete QC of our identification kits, and effectively disseminate the data to all participants.

We began by consolidating our monthly standing orders for kits. Our laboratories had long used a single vendor, but each facility ordered and paid for its own media. By banding together, we qualified for a volume discount that sliced several thousand dollars off our aggregate annual bill. This cost reduction was in addition to the quality control savings achieved by our program.

To streamline quality control procedures, we asked our supplier to limit the group's monthly shipment to a single lot number for each kit. The firm agreed and even went us one better. Because of our size, the quality control organisms suggested by the manufacturer were provided to us at no additional cost.

Each lab using the kit chose two of the organisms on which to perform complete quality control with each new lot number. One lab used an uninoculated strip or plate to act as a sterility control. Once the work was completed, the results were entered on a standard form, which included the kit type, lot number, date tested, results, comments, and initials of the technologist who performed the testing.

Through the courier system, the results were forwarded to the other participating labs. When different labs received the report forms, staff members had only to check their lot numbers to verify that the necessary quality control had been performed.

In another step toward standardized quality control, the group's microbiology committee developed a list of recommended identification kits for routine use. The list covers basic microbiological needs in the labs and serves as a guide for ordering. Technologists are free to test any new products they feel might benefit the group. But they must first clear the suggestion with the microbiology committee so that proper quality control can be implemented if the item is added to the standard list.

Special situations or needs were also addressed. Any laboratory performing unique work to fit a certain patient population was allowed to select its own identification method. So if a lab with a large number of requests for Legionella pneumophilia cultures chose to test in-house instead of sending out the work, it would purchase the kit and maintain quality control.

An unforeseen benefit resulted. Other participating labs could now refer this work locally, which decreased the turnaround time and increased the expertise of the reference tab. The volume generated by the referrals gave the technologists added experience while at the same time kits were kept from outdating. We found that these special situations represented less than 10 per cent of the group's total usage.

One hospital has access to an ultra-low ( - 70 C) freezer, so we can store a large number of stock organisms to accommodate almost any microbiological QC need. When one of our participating laboratories runs across an unusual organism, we add it to the collection.

We have also acquired organisms from the College of American Pathologists' surveys and the American Type Culture Collection. The freezer's convenient location lets us maintain this comprehensive collection at no extra cost to the labs.

We established standard guidelines to be put into effect if a quality control problem was encountered. First, the test is to be repeated with a fresh isolate or with a subculture from our culture collection. Continued QC failure would lead to notification of the supplier and a request for replacement kits to all labs. This measure is a "fail-safe" plan that has yet to be used, as without exception, all kits ordered have passed our quality control.

To trim costs further and facilitate cooperation among the 16 participating labs, the microbiology committee tries to make group decisions when selecting new instruments or supplies. The committee's six members meet once a month over lunch. I serve as the committee's chairman. Other members include a pathologist, technologists from the other hospital labs, and a representative of the outpatient laboratories.

When the committee is studying a specific problem, it is likely to turn the investigation over to one or two interested technologists. They deliver progress reports at the monthly meetings until all the data are in. It usually takes two or three months to complete a study. The committee used this approach when it decided to switch all of the laboratories to the same commercially prepared plates for minimum inhibitory concentration determinations, and again to update the group's protocol for identification of enteric pathogens.

We encourage consultations between various sites. The technologists swap unusual organisms, help each other troubleshoot problems, and keep each other informed of new tests and trends. They also make suggestions to the microbiology committee by contacting their representatives. The committee concept has worked so well that we have expanded its concerns to include problem organisms, continuing education, procedural updates, and technological advances.

We have passed both our JCAHO and CAP inspections with flying colors, and the surveyors not only approved of our quality control program but also commended our efforts and ingenuity. We are meeting all the necessary QC requirements and saving money doing it.

Of course, the individual labs still perform quality control-catalase, coagulase, and oxidase tests-to comply with CAP recommendations. The group also requires labs to carry out periodic quality control of susceptibility testing, Gram stains, serotyping, and reagent activity. Weekly susceptibility monitoring is a sound QC measure that should be performed by laboratorians reading the tests.

Even with this additional QC, we have managed to slash the cost of maintaining large numbers of stock cultures and performing exhaustive on-site inoculation and incubation. The bonus of increased communication among the facilities and professional interaction during our monthly committee meetings is incalculable in dollars and cents.

While our particular organizational structure has contributed to the program's success, there is no reason why completely unaffiliated laboratories cannot pool their resources to save money. This is an ideal approach for smaller hospitals trying to cut costs without cutting corners-geography is the only limitation to such a plan.
COPYRIGHT 1988 Nelson Publishing
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Copyright 1988 Gale, Cengage Learning. All rights reserved.

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Title Annotation:centralized quality control
Author:Morgan, Jeff W.
Publication:Medical Laboratory Observer
Date:May 1, 1988
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