Reducing laboratory delays in blood culture pathogen identification: a quality improvement project

Sepsis is a medical emergency caused by bacteria in the bloodstream and a dysregulated immune response. It is important to identify the bacteria rapidly so that the patient receives effective antibiotics. Delays are associated with higher mortality levels and poorer clinical outcomes.Guidance requires full bacterial identification (ID) from bottle flagging positive, within 48 hours with older technology and 24 hours with modern platforms. Before this quality improvement project, we were using old technology including Analytical Profile Index (API) biochemical tests. Analysis highlighted very poor performance (mean 60 hours to ID), resulting in limited clinical utility and clinical incidents. There was great frustration among laboratory and clinical staff.This project aimed to reduce the time taken to obtain ID for positive blood cultures to meet the guidance within 6 months. Analysis led to a business case which helped secure funding for new equipment: a Matrix Assisted Laser Desorption Ionisation (MALDI) platform, to replace the time-consuming API process. MALDI uses time-of-flight mass spectrometry producing rapid ID of bacteria in minutes, indirectly (from agar plate colonies) or directly from blood.MALDI was introduced through two Plan-Do-Study-Act cycles, first with indirect analysis, then with direct. This spread the scientific staff training burden. The new process has dramatically reduced the mean time from flagging to pathogen ID to an average of 10.2 hours, and availability of ID within 24 hours has improved from 0% to 95%.We identified other change ideas for improvement (increasing staff availability and new technology for later stages), but these were parked due to time and funding pressures.Although there remain limitations (especially in terms of staffing hours and the onward communication of the ID result), the MALDI platform has revolutionised the sepsis service we can provide, so represents a substantial improvement in the quality of care that our patients can receive.