Case Study

Lab Microbiology Consolidation: Rationale, Benefits, & Strategic Approaches

Accumen Products

  • • Microbiology Consolidation Assessment

Rationale Behind Test Consolidation

In the ever-evolving landscape of healthcare, laboratories play a pivotal role in patient care, diagnosis, and treatment.  One critical aspect of laboratory operations is microbiology, which involves the study of microorganisms, including bacteria, viruses, fungi, and parasites.  Timely and accurate microbiology testing is crucial for diagnosing infectious diseases, guiding treatment decisions, and preventing outbreaks.  This case study explores the rationale and benefits of microbiology consolidation within a healthcare system, as well as when it may not be appropriate to consolidate.

In recent years, hospital laboratory testing consolidation has emerged as a prominent trend within the healthcare industry.  This shift is driven by a variety of factors, including high regulatory burdens and the scarcity of labor resources.  This is especially true in the microbiology lab, where fewer specialists in microbiology are working today than in years past.  The industry shift toward increased automation and the desire for labs to move towards a “Center of Excellence” model also support the idea of centralized testing at one location.  This strategic decision is further prompted by a desire to improve operational efficiency, achieve cost savings, and/or improve quality and patient care.

Accumen Approach

In recent years, hospital laboratory testing consolidation has emerged as a prominent trend within the healthcare industry.  This shift is driven by a variety of factors, including high regulatory burdens and the scarcity of labor resources.  This is especially true in the microbiology lab, where fewer specialists in microbiology are working today than in years past.  The industry shift toward increased automation and the desire for labs to move towards a “Center of Excellence” model also support the idea of centralized testing at one location.  This strategic decision is further prompted by a desire to improve operational efficiency, achieve cost savings, and/or improve quality and patient care.

Assessment:

Conduct a thorough assessment of existing microbiology laboratories within the healthcare system to identify duplication, inefficiency, or opportunities for improvement.

Strategic Planning:

Develop a strategic plan that outlines the goals, timeline, and resources required for consolidation. Consider the needs of all stakeholders, including laboratory staff, physicians, and patients.

Infrastructure Investment:

Invest in the necessary infrastructure, including a centralized facility with appropriate biosafety measures, equipment, and IT systems to support a consolidated microbiology laboratory.

Staff Training and Development:

Provide ongoing training and professional development opportunities for laboratory staff to ensure they are equipped to handle the increased volume and complexity of testing.

Quality Assurance:

Implement robust quality assurance programs and standard operating procedures to maintain or improve the quality of microbiology testing.

Communication:

Maintain open and transparent communication with all stakeholders, including physicians, to ensure a smooth transition to the consolidated laboratory.

Performance Monitoring:

Continuously monitor key performance indicators (KPIs) to track the success of the consolidation effort and to make any necessary adjustments to achieve desired outcomes.

3 Options for Consolidation

The decision to move testing to a single laboratory location, or Center of Excellence, for all tests – or for a subset of specialty testing such as Microbiology.

A hybrid model, where some testing is sent to a central location and other testing is performed at ancillary laboratory locations.

The decision to keep full testing menus at each laboratory location within the healthcare system.

Full Consolidation

“Often the decision to move forward with full consolidation of laboratory testing is driven by the desire to invest in technology such as automation, which promises to improve both productivity and quality,” says Silka Clark, MLS, a Director in Lab Excellence at Accumen. This was the case when a leading nonprofit health system located in the western United States decided to explore the possibility of creating a Microbiology Center of Excellence in 2022.

Microbiology automation can reduce or eliminate the need for specialized personnel trained to set-up specimens for evaluation. Robotic systems can label, plate, and inoculate media, create and stain slides, and store and incubate specimens throughout the growth and evaluation phases of the testing process. Furthermore, automation may improve quality in the microbiology laboratory by adding plate reading and evaluation modules that allow for remote capabilities and image storage, earlier positivity detection through batching, and increased standardization of pathogen detection.

“It was cost prohibitive for this health system to install microbiology automation at all four of their laboratories, so they asked Accumen to evaluate whether consolidation of all microbiology testing to a single location might make it possible to procure automation,” says Clark.

During the assessment, it was identified that there were several areas of duplication across the system. For example, all four laboratories employed Technical Specialists in Microbiology to oversee the regulatory demands, staff training and competency, and inventory management of their labs. All four labs also performed their own culture set-ups, blood cultures, and gram staining, while they had consolidated plate reading and organism identification to their core laboratory.

Through Accumen’s detailed assessment process, they learned that by consolidating the remaining microbiology activities to their core laboratory they could defer up to $850,000 per year in labor costs and concentrate their collective microbiology expertise at the core location. Additionally, they could save approximately $90,000 per year in equipment and consumable costs without needing additional instrumentation, simply by moving the equipment from the ancillary locations to the core lab.

Implementation would require strategic decisions about courier services, as specimens would need to be delivered more frequently than the current schedule. However, those costs are more than covered by the savings.

Decision: The executive laboratory team decided to move forward with full consolidation, as the savings estimates above would provide the necessary ROI to offset the cost of future automation in just a few years.

Partial Consolidation

In the current climate of healthcare, finding enough Medical Laboratory Scientists (MLS) trained or specializing in Microbiology has become increasingly difficult, especially in areas where the cost of living is exceptionally high.  This was the case for a region of one of the nation’s largest nonprofit healthcare systems, located in the Pacific Northwest, in 2023.  In addition, a decision from their national executive team to consolidate Microbiology to a single location for the region was made in accordance with best practices realized within other regions.

“While there are many advantages to a full consolidation of lab services, microbiology specimens are sometimes irreplaceable – meaning if the specimen were lost or compromised in any way, then there would not be an opportunity to collect another one,” says Clark.  “For this reason, the logistics of courier services as well as the timing of specimen transport are critical to the maintenance of quality.”

An assessment by the Accumen team showed that for five of the ancillary hospital locations, consolidation of microbiology to the core laboratory would allow for similar benefits as a full consolidation, however there was one large hospital located over 45 miles away that was already equipped with a full-service microbiology laboratory.  It even included state of the art technology investments that were less than two years old.

Decision: It was decided that while most microbiology specimens would be couriered to the central laboratory’s newly created Microbiology Center of Excellence, the secondary laboratory would continue to maintain a back-up layer of security for the region.  They had the ability to incubate blood cultures onsite, perform set-ups and incubate specimens as needed, and continue to perform their own gram stains.  By keeping the secondary location, they also had a contingency plan if the system needed overflow capabilities, without needing to maintain fully trained microbiologists at that site.

No Consolidation

There is also a scenario where consolidation is not recommended, as was the case for two medium-sized hospitals located in the mid-west, part of one of the largest U.S. health systems. These hospitals, located approximately 1.5 hours apart, had similar test menus and equipment. Hospital leadership was interested in the benefits of consolidating microbiology testing to either one location or the other within the region.

The Accumen team assessed staffing, equipment capacity, test menus, and physical space constraints, among other factors. The assessment showed that there would be little net savings in labor by decreasing staff at one location and adding similar staff at the other. “Though some equipment could be transferred from one location to the other, the blood cultures equipment was not the same model between sites,” says Jennifer White, MLS, a Director in Lab Excellence at Accumen. “This would require a capital purchase and maintenance fees for volumes to be performed on one platform at a location. That, along with the cost of additional couriers for specimens, negated the modest savings associated with staff reductions.”

Decision: It was recommended by Accumen that consolidation not be pursued, neither full nor partial, due to the minimal financial savings. The impact of the change on clinicians outweighed the little advantage. The recommendations were to retain current test menus at each location, continue to identify opportunities for laboratory support staff to work to their fullest potential within microbiology, and utilize commercial reference laboratories for small volume, esoteric testing.

Conclusion

When appropriate, healthcare systems can successfully consolidate their microbiology laboratory services, leading to improved operational efficiency, cost savings, and better patient care. However, there are scenarios where consolidation is not recommended, therefore locations must be thoroughly assessed on a case by case basis.

Accumen’s expertise in healthcare performance improvement can guide organizations through the complex process of microbiology consolidation assessment and implementation, ultimately delivering better outcomes for healthcare providers, patients, and the business.

About Accumen:

Accumen’s team of highly experienced subject matter experts (SMEs) are ready to create and recommend solutions to begin improving operations in your laboratory.  Our methods, processes, and tools are designed to retain staff in a tight labor market, reduce costs, increase revenue, improve processes, and increase patient safety and satisfaction. Some recommendations are department-specific, while many apply broadly to lab management as a whole.

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