Identifying Educational Opportunities from Phonecalls to the Microbiology Laboratory

BACKGROUND: The microbiology laboratory is central to the treatment and surveillance of infectious disease, and effective communication is crucial. We used phone call requests from healthcare providers to the Yale New Haven Hospital microbiology laboratory to identify areas for education and improved result communication. METHODS: Requests for additional testing are routinely documented by medical technologists using a standardized form. These are reviewed by a technologist, clinical pathology resident, microbiology fellow or laboratory director, and further testing is approved or denied. Requests from 8/15/16 to 12/15/16 were analyzed by the rationale for testing, the outcome, and the reason for approving or denying the request. RESULTS: We recorded 497 requests from 411 specimens (Figure 1). 281 requests were for susceptibility testing. 99 were for workup of mixed cultures, 71 of these on the wound bench. Of the remaining 117 classified as other, 57 were calls looking for results, additional information or interpretation of results, followed by testing for Gene Xpert MTB/RIF on 18. 302 requests were approved, 120 denied, and for 75, no further testing was necessary. Of the 195 calls that were either denied or for which no intervention was necessary, 101 calls were for susceptibility testing (Figure 2), 23 for workup of mixed infections, and 71 for a variety of reasons. Non-ID providers made 135 of these calls compared with 58 by ID providers. 87 requests made by non-ID providers were denied compared with 32 by ID providers. These requests were reviewed for educational opportunities (Figure 3). A handout describing laboratory workflow was created for ID fellows and PharmDs. Result reporting and susceptibility testing for specific bug-drug combinations were updated after discussion with antibiotic stewardship. A microbiology ‘survival guide’ will be created for on-call pathology residents. CONCLUSION: Phone call requests to the microbiology laboratory can be used to identify opportunities for education based on provider Background. The electronic medical record can be used for antimicrobial stewardship and result updates. The microbiology laboratory reduces low-value care by educating providers when additional testing is not beneficial. DISCLOSURES: All authors: No reported disclosures.