Pre-analytical barriers to blood culture completion in a large laboratory network

Introduction. Sepsis is a major contributor to the global burden of disease. Its effective treatment is time-critical and relies on timely access to significant blood culture (BC) results.Hypothesis/gap statement. The value of BC results to the requesting service is reduced by delays in report completion. Centralized clinical laboratory networks have little insight into pre-analytical causes of delayed BC results.Aim. We aimed to assess variations in laboratory investigation of bloodstream infection and sepsis throughout a state-wide laboratory network, with the goal to design suitable remedial action.Methodology. We analysed BCs from collection to final reporting in a public pathology service by univariate analysis and supervised machine learning.Results. Of the 5,436 first-positive BCs from all Western Australian (WA) public laboratories in 2023, 1,343 (24.7%) came from regional sources. A total of 1,052 (78.3%) regional BCs were from emergency departments, and 831 (64.5%) of these were collected out of hours, rising during the 24 h cycle. Regional BCs took 33 h more than urban area cultures to reach a final report (103 compared with 70 h). Regional BC Gram stains were delayed by 31 h (69 compared with 38 h) and took over 97 h from collection to report in 25% regional Gram-stain results. Regional BCs added a 15 h delay to first results when significant species were mixed with potential contaminants, and 23 h when mixed with other significant species.Conclusion. In WA, substantial delays to actionable BC results were common. The time taken to transport specimens to a laboratory was a small fraction of these delays. Monitoring of the steps in BC workflow completion can be used to improve the quality and safety of BC service provision within the limits of current technology, though solutions to this critical capability gap vary with location.