D_Curran.jpg (8435 bytes)Of the four component labs that comprise the typical hospital laboratory — blood bank, chemistry, hematology and microbiology — microbiology, at first glance, might look like a discipline that’s ripe for outsourcing. In the eyes of a cost-conscious administrator, it’s expensive and turnaround time can take days.

But what about the downside? For example, the very microorganisms that microbiologists are looking for — bacteria and viruses — are among those least likely to survive a cross-country plane trip in a FedEx package.

Let’s suppose you are a Chicago hospital that outsources your microbiology testing to a Salt Lake City lab? Specimen pick up is at 3 p.m. Monday through Friday. You get a patient specimen at 4:30 p.m. on Friday. That specimen doesn’t get picked up until 3 p.m. on Monday. It gets put on a plane at O’Hare, but the airport is closed due to high winds, and the plane doesn’t leave until Tuesday. The lab in Salt Lake City receives the specimen on Wednesday morning and begins working on it Wednesday night. Now let’s suppose that specimen belongs to a patient who has been kept in the hospital for those five days? Are there really cost savings, and is this a true story? No and yes.

Fortunately, the Infectious Disease Society of America, a group of infectious disease physicians, has taken note of the recent wave of consolidation and outsourcing of microbiology labs. They have developed a policy statement that they hope ultimately will become part of the laboratory accreditation standards of JCAHO, ASCP and CAP.

The policy states, in part, “… clinical microbiology laboratories serve a unique function related to the effective management of infectious diseases. First, data generated by these laboratories are critical for accurate diagnoses and treatment of   infectious diseases. Second, they are the essential backbone of infection control programs in health care institutions, providing crucial hospital-specific surveillance information regarding the prevalence of infectious disease agents and their susceptibility to therapeutic products. Third, in partnership with state health departments and the Centers for Disease Control and Prevention, these laboratories are the first line of defense against emerging microbial threats, including antibiotic resistance and bioterrorism. Fourth, these laboratories provide critical training facilities for infectious disease fellows; the Accreditation Council for Graduate Medical Education requires that clinical microbiology laboratories be in place for both adult and pediatric infectious disease training programs. The American Board of Internal Medicine and the American Board of pediatrics also require access to laboratory facilities to meet eligibility requirements for infectious disease subspecialty certification. All of these functions are threatened if the laboratories are located at such distances from the patients and physicians that transportation of specimens containing fragile microorganisms, communication among laboratory personnel and health care providers, and/or physician access to timely diagnosis reporting and personal analysis of specimens is compromised.”

The entire policy statement can be found on the Web site, www.journals.uchicago.edu/CID.

It’s true that healthcare institutions are facing a real financial crunch, and administrators are leaving no stone unturned in their quest to save money. However, reducing the number of FTEs is not always equivalent to saving actual money. Besides, some hospital services are just plain worth the cost, and having high quality microbiology laboratories within close proximity to patients is one of them.

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Coleen Curran