Addressing the key communication barriers between microbiology laboratories and clinical units: a qualitative study

J Antimicrob Chemother Addressing the key communication barriers between microbiology laboratories and clinical units: a qualitative study Brita Skodvin 2 Karina Aase 1 Anita Løva˚ s Brekken 0 Esmita Charani 5 Paul Christoffer Lindemann 3 4 Ingrid Smith 2 4 0 Department of Microbiology, Stavanger University Hospital , 4068 Stavanger , Norway 1 Department of Health Studies, University of Stavanger , 4036 Stavanger , Norway 2 Norwegian Advisory Unit for Antibiotic Use in Hospitals, Department of Research and Development, Haukeland University Hospital , 5021 Bergen , Norway 3 Department of Microbiology, Haukeland University Hospital , 5021 Bergen , Norway 4 Department of Clinical Science, University of Bergen , 5020 Bergen , Norway 5 National Institute of Health Research Health Protection Research Unit- Antimicrobial Resistance and Healthcare Associated Infection, Imperial College London, Hammersmith Hospital , London W12 OHS , UK Background: Many countries are on the brink of establishing antibiotic stewardship programmes in hospitals nationwide. In a previous study we found that communication between microbiology laboratories and clinical units is a barrier to implementing efficient antibiotic stewardship programmes in Norway. We have now addressed the key communication barriers between microbiology laboratories and clinical units from a laboratory point of view. Methods: Qualitative semi-structured interviews were conducted with 18 employees (managers, doctors and technicians) from six diverse Norwegian microbiological laboratories, representing all four regional health authorities. Interviews were recorded and transcribed verbatim. Thematic analysis was applied, identifying emergent themes, subthemes and corresponding descriptions. Results: The main barrier to communication is disruption involving specimen logistics, information on request forms, verbal reporting of test results and information transfer between poorly integrated IT systems. Furthermore, communication is challenged by lack of insight into each other's area of expertise and limited provision of laboratory services, leading to prolonged turnaround time, limited advisory services and restricted opening hours. Conclusions: Communication between microbiology laboratories and clinical units can be improved by a review of testing processes, educational programmes to increase insights into the other's area of expertise, an evaluation of work tasks and expansion of rapid and point-of-care test services. Antibiotic stewardship programmes may serve as a valuable framework to establish these measures. Introduction In Norway, implementation of antibiotic stewardship programmes (ASPs) is in its early stages.1 One of the core elements of ASPs is access to microbiology laboratory services.2,3 Microbiology laboratories are critical in surveillance of antibiotic resistance, development of empirical antibiotic treatment guidelines and guidance of clinical staff in the diagnosis and treatment of infections. Rapid delivery of microbiology test results has been shown to influence mortality, length of hospital stay and costs, as well as appropriateness of antibiotic prescribing and consumption, which are the main drivers for development of antibiotic resistance.4–7 In a previous study on antibiotic prescribing in hospitals, we found that clinicians perceived communication of microbiology test results as inadequate and a barrier to effective antibiotic stewardship.8 Processes involving communication between laboratories and clinical units are the most error-prone parts of laboratory testing.9,10 Up to 30% of adverse events in laboratory medicine impact patient care and up to 12% of the events cause actual or potential harm to patients.11,12 Taking into account the high volume of testing, such errors may significantly affect patient safety and public health globally, highlighting the need to review laboratory testing processes. Norway has a dispersed geography with a variety of small, medium and large hospitals. There are 48 hospitals nationwide, of which 45 are public. Only 16 hospitals have on-site microbiology laboratories and hospitals without them send samples to the nearest hospital with such facilities. All laboratories are open during the daytime 6–7 days a week. Some hospitals provide a microbiology service in the evening, but none during the night. This evidently challenges communication between the microbiology laboratories and the clinical units. Based on our previous findings that clinicians were dissatisfied with the communication between microbiology laboratories and clinical units, we proceeded to study the communication between the two from a laboratory point of view. In this study we investigate communication barriers between microbiology laboratories and clinical units, and how they can be addressed. To our knowledge this is the first published study on this topic. Methods Study design A qualitative design, using semi-structured interv (...truncated)