COST AND TIME SAVINGS FOLLOWING INTRODUCTION OF REJECTION CRITERIA FOR CLINICAL SPECIMENS

We have evaluated the yield of several tests and have instituted speci men rejection criteria to reduce costs and save time. For a 12-month p eriod, we recorded the reduction of these tests and calculated the res ultant cost and time savings. Seven changes were analyzed: not perform ing fungal or mycobacterial (acid-fast bacillus) cultures on cerebrosp inal fluid (CSF) specimens from patients without known immunosuppressi on when chemistry and cell count are normal; not performing routine st ool culture or ovum and parasite examination on specimens from patient s in the hospital for >3 days; not culturing endotracheal suction aspi rates when no organisms or >10 squamous epithelial cells are present; discontinuing broth cultures on all specimens except for tissue, conti nuous ambulatory peritoneal dialysis fluid, and CSF from patients with shunts; and eliminating bacterial antigen tests. For each test, the n umber not performed (n), reagent savings, and technologist time saved, respectively, were as follows: CSF fungal culture, 267, $999, and 67 h; CSF acid-fast bacillus culture, 275, $1,662, and 124 h; stool cultu res, 320, $2,991, and 98 h; ovum and parasite examinations, 216, $525, and 108 h; endotracheal suction aspirate cultures, 1,505, $4,447, and 306 h; broth cultures, 5,218, $4,931, and 80 h; and bacterial antigen tests, 2,598, $2,293, and 299 h. Overall, 5,181 tests were rejected a nd 5,218 broth cultures were omitted. Achievable savings were $28,000 in reagent costs and 1,082 h of technologist time. In conclusion, reje cting specimens of proven low yield saves reagent costs and, more impo rtantly, saves technologist time. This time can be spent on specimens having greater diagnostic utility.