Control of cost and medical relevance in clinical microbiology

Government and third-party payers are applying increasing effort to control rising medical laboratory costs by restricting laboratory budgets. This threatens quality in clinical microbiology, where lack of automation has hampered increased productivity. A solution was sought by curtailing work on duplicates and specimens of poor quality using empirically derived objective criteria. One to 43% of specimens of various types were of insufficient quality to warrant planting, and 6-95% of isolates obtained in mixed culture were not subject to complete bacteriologic work-up because of evidence of superficial contamination. Combined with other controls this reduced bacteriology laboratory costs by 12%. Simultaneously, preliminary reports of examination of direct smears were provided for most specimens, and telephone reports were rendered when processing was incomplete to allow prompt resubmission of specimens. The impression that the information contributed to more rapid accurate diagnosis and treatment of infectious disease was gained.