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Oxford University Hospitals NHS Foundation Trust
Microbiology

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How we ensure our service is efficient

Year on year the Microbiology Department of the Oxford University Hospitals (OUH) continues to process more samples from Oxfordshire GPs, patients and referred work from laboratories outside the area.

The number of samples being processed in the laboratory continues to increase by 2-3 percent annually, with the workload by 2016 being over 650,000 tests each year.

The NHS has been asked by the government to improve efficiency, so OUH and consequently the Microbiology Department face increasing pressure to reduce costs and increase efficiency whilst continuing to provide the quality of service demanded by our users.

The number of users isn't set to decline; in fact, the Carter Review of 2008 states that over the next 25 years the number of people in the UK aged over 65 will increase by 63 percent. Those aged 85 and over will more than double and together they will represent over a quarter of the population.

(Report of the Second Phase of the Review of NHS Pathology Services in England. Chaired by Lord Carter of Coles. Dec 2008 (pdf)

As the elderly are known to have a higher incidence of chronic disease, the cost of laboratory testing will increase considerably. Adding to the growing demand for laboratory testing is the increased expectation of the both the clinicians and patients to decrease turn-around times and offer a wider range of tests.

Focused requesting

Focused requesting is a set of strategies set up by the laboratory to help doctors use the Microbiology Laboratory services more efficiently.

This of course may lead to increased testing in some cases (Jackson BR. Managing laboratory test use: principles and tools. Clin Lab Med. 2007 Dec;27(4):733-48), but by employing modern systems and procedures and calling on the wealth of knowledge of clinicians and laboratory staff, this can all be managed to provide higher-quality, cost effective care with improved patient outcome.

Guidelines

Microbiology is a demand-led specialty, and guidelines to advise users covering all high volume specimen types have been introduced here at OUH.

Areas where the most significant changes have been made are:

  • investigation of urinary tract infection
  • vaginal discharge
  • respiratory infections
  • surface cultures for from skin ulcers etc.
  • examination of faeces in gastroenteritis.

Detailed guidelines have been drawn up both within the laboratory, in primary care and within OUH, focusing on the patients symptoms so as only those samples expected to yield a positive outcome are sent to the laboratory.

Of the samples being sent, investigation is limited to the most likely cause according to the details given by the requesting clinician. Of course, this cannot always be the case, and the laboratory is always willing to discuss individual cases with the patient's clinician.

Automation

The laboratory is also constantly reviewing and updating all procedures to take into account new developments in infectious disease. Not all testing is able to be streamlined in this way, and how we overcome this is to employ automation. Automation allows us to process large numbers of samples with increased efficiency, faster turn-around times and high-quality consistent results.

We have a number of machines helping us in the Microbiology Laboratory.

  • The Abbott Architect™ i2000SR processes the majority of our samples requiring viral serology.
  • The BD VIPER™ processes large numbers of screening swabs for sexually transmitted infection.
  • The BD BACTEC™ FX automates the culture of blood samples in the investigation of bacteraemia and septicaemia.
  • The BD Kiestra™ is used to automate the processing of urine samples and MRSA screens from inoculation of culture media right through to plate reading.
  • The BD MAX™ an automated molecular platform used here to screen stool samples for enteric bacterial pathogens

Automated systems often require less input from Biomedical Scientists, and can be run by laboratory support staff, freeing-up Biomedical Scientists to focus on higher quality, lower throughput samples.

An example of this is seen in the Antimicrobial susceptibility testing section where the bulk of the work automated using the BD Phoenix™ and the more skilled manual susceptibility testing is carried out by Biomedical Scientists and Associate Practioner. As of 2015, the time taken to produce a species identification has been reduced by up to a day using the Bruker Microflex™ MALDI-TOF, which revolutionised the way the workflow in the laboratory is managed.