title: Improving positive blood culture removal time significantly decreases total processing time.
abstract: BACKGROUND
  Timely processing of blood cultures with positive results, including Gram staining and notification of clinicians, is a critical function of the clinical microbiology laboratory. Analysis of processing time in our laboratory revealed opportunities to enhance workflow efficiency. We found that the average time from positive blood culture result to removal of the bottle for processing (positive-to-removal [PR] time) was inadequate for our rapid pathogen identification program.
  
  
  OBJECTIVE
  To determine whether increased vigilance about PR time and prioritization of laboratory resources would decrease PR time and total processing time.
  
  
  METHODS
  We performed a retrospective analysis of blood culture PR time 7 months before and 7 months after an in-service meeting during which the importance of PR time was emphasized, and corrective measures were implemented.
  
  
  RESULTS
  Before the in-service meeting, the average PR time for 5057 samples was 38 minutes, with an aggregate time of 192,251 minutes. Unexpectedly, we discovered that only 51.8% (2617 of 5057) of the positive blood cultures were removed in less than 10 minutes. After the in-service meeting, for 5293 samples, the average PR time improved to 8 minutes, the aggregate time improved to 44,630 minutes, and 84.5% (4470 of 5293) of the positive blood cultures were removed in less than 10 minutes. These improvements reduced the time to telephone notification of the Gram stain results to a caregiver by 46.7% (from 105 minutes to 56 minutes).
  
  
  CONCLUSIONS
  Increased awareness of barriers to rapid pathogen identification and interventions for improving performance time significantly enhanced care of patients with bloodstream infections.
authors.affiliation: From the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas.
authors.forename: Eric
authors.initials: E
authors.lastname: Salazar
authors.forename: Mukul
authors.initials: M
authors.lastname: Divatia
authors.forename: Patricia L
authors.initials: PL
authors.lastname: Cernoch
authors.forename: Randall J
authors.initials: RJ
authors.lastname: Olsen
authors.forename: S Wesley
authors.initials: SW
authors.lastname: Long
authors.forename: Geoffrey A
authors.initials: GA
authors.lastname: Land
authors.forename: James R
authors.initials: JR
authors.lastname: Davis
authors.forename: James M
authors.initials: JM
authors.lastname: Musser
mesh_terms: D016470:Bacteremia / Q000175:diagnosis* / Q000382:microbiology; D001769:Blood / Q000382:microbiology*; D016469:Fungemia / Q000175:diagnosis* / Q000382:microbiology; D006801:Humans; D007755:Laboratories, Hospital; D008828:Microbiological Techniques / Q000295:instrumentation / Q000379:methods / Q000592:standards*; D012189:Retrospective Studies; D019032:Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization; D013997:Time Factors