Aj. Morris et al., COST AND TIME SAVINGS FOLLOWING INTRODUCTION OF REJECTION CRITERIA FOR CLINICAL SPECIMENS, Journal of clinical microbiology, 34(2), 1996, pp. 355-357
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.