title: The SUCCESS model for laboratory performance and execution of rapid molecular diagnostics in patients with sepsis.
abstract: Successful performance and execution of rapid diagnostics in a clinical laboratory hinges heavily on careful validation, accurate and timely communication of results, and real-time quality monitoring. Laboratories must develop strategies to integrate diagnostics with stewardship and evidence-based clinical practice guidelines. We present a collaborative SUCCESS model for execution and monitoring of rapid sepsis diagnostics to facilitate timely treatment. Six months after execution of the Verigene Gram-Positive Blood Culture (BC-GP) and the AdvanDx PNA-FISH assays, data were collected on 579 and 28 episodes of bacteremia and fungemia, respectively. Clinical testing was executed using a SUCCESS model comprising the following components: stewardship, utilization of resources, core strategies, concierge services, education, support, and surveillance. Stewardship needs were identified by evaluating the specialty services benefiting from new testing. Utilization of resources was optimized by reviewing current treatment strategies and antibiogram and formulary options. Core strategies consisted of input from infectious disease leadership, pharmacy, and laboratory staff. Concierge services included automated Micro-eUpdate and physician-friendly actionable reports. Education modules were user-specific, and support was provided through a dedicated 24/7 microbiology hotline. Surveillance was performed by daily audit by the director. Using the SUCCESS model, the turnaround time for the detailed report with actionable guidelines to the physician was ∼3 hours from the time of culture positivity. The overall correlation between rapid methods and culture was 94% (546/579). Discrepant results were predominantly contaminants such as a coagulase-negative staphylococci or viridans streptococci in mixed cultures. SUCCESS is a cost-effective and easily adaptable model for clinical laboratories with limited stewardship resources.
authors.affiliation: med fusion Laboratory, Lewisville, TX (Dekmezian, Beal, Damashek, Benavides, Dhiman), and the Department of Pathology and Laboratory Medicine, Baylor University Medical Center at Dallas, Dallas, Texas (Dekmezian, Beal, Benavides).
authors.forename: Mhair
authors.initials: M
authors.lastname: Dekmezian
authors.affiliation: med fusion Laboratory, Lewisville, TX (Dekmezian, Beal, Damashek, Benavides, Dhiman), and the Department of Pathology and Laboratory Medicine, Baylor University Medical Center at Dallas, Dallas, Texas (Dekmezian, Beal, Benavides).
authors.forename: Stacy G
authors.initials: SG
authors.lastname: Beal
authors.affiliation: med fusion Laboratory, Lewisville, TX (Dekmezian, Beal, Damashek, Benavides, Dhiman), and the Department of Pathology and Laboratory Medicine, Baylor University Medical Center at Dallas, Dallas, Texas (Dekmezian, Beal, Benavides).
authors.forename: Mary Jane
authors.initials: MJ
authors.lastname: Damashek
authors.affiliation: med fusion Laboratory, Lewisville, TX (Dekmezian, Beal, Damashek, Benavides, Dhiman), and the Department of Pathology and Laboratory Medicine, Baylor University Medical Center at Dallas, Dallas, Texas (Dekmezian, Beal, Benavides).
authors.forename: Raul
authors.initials: R
authors.lastname: Benavides
authors.affiliation: med fusion Laboratory, Lewisville, TX (Dekmezian, Beal, Damashek, Benavides, Dhiman), and the Department of Pathology and Laboratory Medicine, Baylor University Medical Center at Dallas, Dallas, Texas (Dekmezian, Beal, Benavides).
authors.forename: Neelam
authors.initials: N
authors.lastname: Dhiman
references.citation: Crit Care Med. 2010 Apr;38(4):1045-53
references.pmid: 20048677
references.citation: Clin Infect Dis. 2010 Nov 1;51(9):1074-80
references.pmid: 20879856
references.citation: Proc (Bayl Univ Med Cent). 2015 Apr;28(2):139-43
references.pmid: 25829639
references.citation: PLoS Med. 2013;10(7):e1001478
references.pmid: 23843749
references.citation: Crit Care Med. 2002 Nov;30(11):2462-7
references.pmid: 12441755
references.citation: J Clin Microbiol. 2013 Nov;51(11):3869-71
references.pmid: 23985910
references.citation: J Clin Microbiol. 2013 Dec;51(12):4150-5
references.pmid: 24108609
references.citation: J Clin Microbiol. 2013 Nov;51(11):3579-84
references.pmid: 23966484
references.citation: J Clin Microbiol. 2013 Dec;51(12):3988-92
references.pmid: 24048531
references.citation: Eur J Clin Microbiol Infect Dis. 2006 Mar;25(3):181-5
references.pmid: 16505987
references.citation: Microbiology. 2010 Jan;156(Pt 1):184-90
references.pmid: 19850619
references.citation: Clin Infect Dis. 2003 Jun 1;36(11):1418-23
references.pmid: 12766837
references.citation: Interdiscip Perspect Infect Dis. 2012;2012:765205
references.pmid: 22919379
references.citation: J Clin Microbiol. 2013 Dec;51(12):4008-11
references.pmid: 24068006
references.citation: J Clin Microbiol. 2014 Jan;52(1):283-7
references.pmid: 24131696
references.citation: Mol Diagn Ther. 2013 Apr;17(2):117-22
references.pmid: 23345071
references.citation: J Clin Microbiol. 2013 Jul;51(7):2072-6
references.pmid: 23596240
references.citation: Crit Care Med. 2006 Jun;34(6):1589-96
references.pmid: 16625125
references.citation: Arch Med Res. 2005 Nov-Dec;36(6):646-59
references.pmid: 16216646
references.citation: Methods Mol Biol. 2014;1050:167-78
references.pmid: 24297359