[Enhanced quality in a hospital microbiology laboratory: from automation to clinical advice]

Quality policies focussed on the patient and applied to a hospital microbiology laboratory have led us to investigate clinicians' needs when requesting test results. The aim of this study was to analyze these requirements and to implement a plan to improve attention to the clinicians, considered as direct customers, particularly in the process of providing results.

Phase 1: To determine clinicians' needs, we studied the calls made to the Bacteriology Unit. Over a period of two weeks the information requested, the reasons for the call and the hospital Service calling were recorded. A descriptive analysis of this information was performed and the most frequent reasons for calling were identified. Phase 2: A quality improvement plan was designed to improve laboratory reporting of bacteriologic results. One month after its implementation, the results of this quality effort were assessed by analysis of calls to the Unit and use of a questionnaire to determine clinicians' satisfaction.

Phase 1: among the total calls made, 43.8% asked for information on specimens being processed, 17.7% for information on specimens processed in other units, 16.1% demanded test results that had not been received within the expected time, and 22.4% were for other reasons. The hospital departments requesting information included 31% Infectious Diseases, 16% Internal Medicine, 13% Intensive Care Unit (ICU), and 40% others. Phase 2: within the quality plan, a microbiologist attended clinical sessions in the above mentioned departments in order to provide information on the specimens being processed, to discuss alternative diagnostic tests, and to comment on treatment prescribed to the patients.

Microbiologists attended two sessions per week during one month in the IM and ID Departments and ICU, and his/her participation was evaluated through analysis of calls and a satisfaction questionnaire.

Automation of many laboratory tasks has allowed a reorientation of the activity of laboratory professionals toward satisfying the needs of the medical staff and improvements in the reporting process. The direct participation of laboratory professionals in discussions on patient care resulted in an enhancement of the overall quality of the health care provided to the patient.