Clinical microbiology includes bacteriology and antimicrobial
susceptibility testing, virology, parasitology, mycobacteriology, mycology,
serology and molecular microbiology. Unlike the core laboratory(chemistry/hematology), where the majority of testing is performed
on highly automated analyzers, most testing in microbiology is
performed manually or on semi-automated platforms. Many microbiology
tests also require interpretation by a skilled microbiology technologist,
including visual interpretation of culture results and microscopic
examinations. For these reasons the unit cost of microbiology testing
is usually greater than that for routine automated testing. The results
of microbiology tests have a significant impact on the overall cost of
clinical care, most notably in the use and selection of antimicrobial therapy. Therefore, when approaching utilization management in
microbiology, it is important to consider not only the cost of testing
within the microbiology laboratory but also the downstream costs
resulting from clinical decisions based on the test results.
The published literature on utilization management in microbiology
is relatively limited when compared to reports on managing utilization
of routine automated testing in the chemistry and hematology laboratories.
This article will outline a number of utilization management interventions
in microbiology that have been reported in the literature. We
will also describe several unpublished initiatives that have proven successful
in our institution. The specific interventions to be discussed are
outlined in Table 1, and will be described in more detail in the text
that follows. In a number of cases, the initiative's success arose not
only from a reduction in laboratory testing per se, but rather also from
its impact in the clinical care arena (for example, a reduction in antibiotic
use or hospital length of length-of-stay). This observation highlights
the importance of the clinical microbiology director in forming collaborative,
interdepartmental teams to improve quality and reduce the cost
of medical care