Redesigning Microbiology Order Architecture to Improve Laboratory Efficiency

Clinical microbiology culture interpretation depends on accurate specimen context, including specimen type, anatomic source, and collection method. However, electronic ordering systems often permit nonspecific culture orders that do not capture the information needed for appropriate processing, reporting, and result interpretation.

We performed a quality improvement intervention at an academic tertiary care center to replace a generic "aerobic culture" order with specimen-specific wound, sterile body fluid, and tissue/biopsy culture orders linked to required specimen type and anatomic source fields. Ordering pathways were harmonized across procedural and nonprocedural work flows, and available tests were constrained based on the selected specimen type and source.

Before intervention, 1115 of 2528 eligible culture orders required laboratory cancellation and reordering, compared with 78 of 508 eligible orders after implementation, 44.1% vs 15.4%, risk ratio 0.35, 95% CI 0.28-0.43, P < 0.001. Generic aerobic culture ordering declined to zero 5 months after residual ordering pathways were identified and corrected. Remaining errors were largely attributable to retained preference-list orders, previously placed future or standing orders, and gaps in clinician education.

Specimen-specific microbiology order design reduced preanalytical ordering error and laboratory rework. These findings support microbiology order architecture as a practical diagnostic stewardship strategy that can improve specimen-context capture, reduce downstream laboratory correction, and better align culture ordering with laboratory processing requirements.