Evolving approaches to management of quality in clinical microbiology

Bartlett, Raymond C.; Mazens-Sullivan, Mary F.; Tetreault, Janice; Lobel, S; Nivard, Jacqueline

doi:10.1128/cmr.7.1.55

Cited by 40 publications

(28 citation statements)

References 138 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The need to ensure appropriate, cost effective diagnostic testing has prompted many laboratories to reassess the microbiology services they offer (6)(7)(8). Robinson (9) has recently reviewed the rationale for cost effective laboratory medicine, and has identified the need to determine critically whether costly changes in technology actually benefit patient care.…”

mentioning

confidence: 99%

Evaluation of Routine Enteric Pathogens in Hospitalized Patients: A Canadian Perspective

Gough

Alfa

Harding

1996

Canadian Journal of Infectious Diseases and Medical Microbiolog

View full text Add to dashboard Cite

K GOUGH, M ALFA, G HARDING. Evaluation of routine enteric pathogens in hospitalized patients: A Canadian perspective. Can J Infect Dis 1996;7(3):197-202. Diarrhea is a frequently encountered problem in hospitalized patients. Since nosocomial spread of routine enteric pathogens such as Salmonella species, Shigella species, Campylobacter species and Escherichia coli O:157 H:7 seldom occurs, testing for these organisms in patients hospitalized for longer than three days has been questioned. The goal of this study was to determine the length of hospitalization preceding detection of routine enteric pathogens and Clostridium difficile cytotoxin, and to develop guidelines for enteric cultures from hospitalized patients. The enteric pathogens detected in 1991 were C difficile toxin B(+), 77%; Campylobacter species, 10%; Salmonella species, 9%; E coli O:157 H:7, 3%; and Shigella species, 1%. For 1992, these numbers were 86%, 9%, 3%, 2% and 0%, respectively. None of the routine enteric pathogens isolated in 1991 or 1992 was detected in patients after their second day of hospitalization. Routine cultures for enteric pathogens on hospitalized patients were eliminated in February 1993, and physician ordering practices were monitored. With the exception of one campylobacter isolate per year, all routine enteric pathogens isolated in 1993 and 1994 were detected by the second day of hospitalization. Compliance with the changed protocol was 76% measured over a four-month period in 1993 and 74% over the year 1994. Savings of $3,648.10 were associated with rejecting 191 'inappropriate' specimens in 1994. It was concluded that routine enteric cultures are unnecessary for patients hospitalized more than two days, and that appreciable financial savings can be achieved if revised protocols for processing stool cultures are instituted. However, when enteric protocol changes are in place compliance must be evaluated to ensure appropriate utilization. Key Words: Clostridium difficile, Diarrhea, Enteric pathogens, Length of hospitalization, Nosocomial infection, Stool processingÉvaluation des organismes pathogènes entériques habituels chez les patients hospitalisés : perspective canadienne RÉSUMÉ : La diarrhée est un problème fréquent chez les patients hospitalisés. Étant donné que la propagation nosocomiale des organismes pathogènes entériques comme Salmonella, Shigella, Campylobacter et Escherichia coli O157H:7 survient rarement, le dépistage de ces organismes pathogènes chez les patients hospitalisés pendant plus de trois jours a été remis en question. L'objectif de cette étude était de déterminer la durée du séjour hospitalier précédant un dépistage des organismes pathogènes entériques courants et de la cytotoxine de Clostridium difficile et de mettre au point des directives de cultures entériques chez les patients hospitalisés. Les organismes pathogènes entériques décelés en 1991 étaient la toxine B(+) de C. difficile 77 %; le genre Campylobacter 10 %, le genre Salmonella 9 %, E. coli O157H:7 voir page suivante

show abstract

mentioning

confidence: 99%

Evaluation of Routine Enteric Pathogens in Hospitalized Patients: A Canadian Perspective

Gough

Alfa

Harding

1996

Canadian Journal of Infectious Diseases and Medical Microbiolog

View full text Add to dashboard Cite

show abstract

“…They fall into two main groups: identification and susceptibility testing instruments and blood culture systems. Whereas some identification and susceptibility testing instruments take as long as traditional methods, others provide results within a single working day 4. The full healthcare benefits are seen when a laboratory is staffed 24 hours each day and doctors are available to receive and act on the information day or night.…”

Section: New Diagnostic Methodsmentioning

confidence: 99%

“…Nucleic acid amplification systems are available for the direct detection in clinical specimens of hepatitis C virus, HIV, M tuberculosis , C trachomatis , and N gonorrhoeae . 4 10 11…”

Section: New Diagnostic Methodsmentioning

confidence: 99%

Recent advances: Medical microbiology

Richardson

Smaill²

1998

BMJ

View full text Add to dashboard Cite

“…In contrast with the implicit group, these studies concentrated on single laboratory 108,115 and other specialty societies. 111 Local expert opinion was specified for criteria derivation in some studies 76,106,107,109,[116][117][118] but the methods used to elicit these opinions were not delineated. Rhyne 98 and pharmacology* were used for criteria in the remaining studies.…”

Section: Studies Using Explicit Appropriateness Criteriamentioning

confidence: 99%

Do We Know What Inappropriate Laboratory Utilization Is?

Walraven¹,

Naylor²

1998

JAMA

313

View full text Add to dashboard Cite

Objective.-Laboratory utilization has steadily increased, and some studies suggest inappropriate utilization. Therefore, we wished to assess studies that measure inappropriate laboratory use in light of methodological criteria.Design.-Systematic review of published studies. Data Sources.-MEDLINE, HEALTHSTAR, and EMBASE databases were searched from 1966 to September 1997 using a broad and inclusive strategy with no language restriction. In addition, the references of all retrieved studies and 3 textbooks on diagnostic testing were hand-searched.Study Selection.-All studies that provided and applied criteria for inappropriate laboratory use.Data Extraction.-Studies were categorized based on whether the criteria were implicit (objective criteria for inappropriate utilization not provided or very broad) or explicit. Guidelines for evaluation were applied to each study by a single reviewer.Data Synthesis.-Forty-four eligible studies were identified. Eleven studies used implicit criteria for inappropriate laboratory utilization and contained small numbers of patients or physicians. Most did not adequately assess the reliability of the implicit criteria. Thirty-three studies used explicit criteria based on the appropriateness of test choice, frequency, and timing, as well as the probability of a positive result. There were large variations in the estimates of inappropriate laboratory use (4.5%-95%). Evidence supporting the explicit criteria was frequently weak by the standards suggested for therapeutic maneuvers, but was nonetheless compelling based on principles of physiology, pharmacology, and probability.Conclusions.-Many studies identify inappropriate laboratory use based on implicit or explicit criteria that do not meet methodological standards suggested for audits of therapeutic maneuvers. Researchers should develop alternative evidentiary standards for measuring inappropriateness of laboratory test use.

show abstract

Evolving approaches to management of quality in clinical microbiology

Cited by 40 publications

References 138 publications

Evaluation of Routine Enteric Pathogens in Hospitalized Patients: A Canadian Perspective

Evaluation of Routine Enteric Pathogens in Hospitalized Patients: A Canadian Perspective

Recent advances: Medical microbiology

Do We Know What Inappropriate Laboratory Utilization Is?

Contact Info

Product

Resources

About