Standard Expenditure Needs and Standard Level of Services in microbiology laboratories: a pilot study on blood cultures management

DOI 10.23753/htafocus2016.01.002

Andrea Rocchetti, Claudio Farina, Roberto Ippoliti on behalf of the APSI working group


Introduction: Blood culture is the gold standard for sepsis diagnosis and so microbiology laboratories (labs) invest daily substantial human and technological resources to satisfy the demand of increasing diagnostic investigations. This pilot study is aimed at monitoring the performance of a selected sample of microbiology labs, evaluating both the Standard Expenditure Needs (SEN) of blood cultures for diagnostic investigations and the Standard Level of Services (SLS), i.e. the number of (per patient) bottles, which can represent an appropriate proxy of the best practice in performing this specific investigation.
Materials and Methods: The proposed approach is based on the four quadrants model. On one hand, the per hospital theoretical and historical SEN and, on the other one, the per hospital theoretical and actual SLS have been evaluated. Afterwards, combining both estimations, authors proposed a joint graphical analysis to monitor the performance of microbiology labs. Sixteen Italian microbiology labs belonging to as many hospitals participated to the survey.
Results: According to the four quadrants model approach, authors estimated that 25% of observations represented non virtuosos labs while 12,5% were virtuosos labs, as well 37,5% were over performing labs while 25% were under performing labs. Moreover, findings supported the existence of economies of scale.
Conclusions: The proposed methodology is a dynamic tool, able to identify best practices and, at the same time, to assess labs’ performance. Moreover, working on a network of labs, the proposed benchmarking analysis can stimulate the debate among microbiologists, considering both the internal organization and the necessary technology.


Key words: blood culture; microbiology laboratories; standard cost; Regression based Cost Approach (RCA)