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Quality Tools to Ensure Patient Safety and Reduce the Turnaround Time of Medical Laboratories in Tertiary Care Teaching Hospitals
Puja Kumari Jha, Rachna Agarwal, Rafat Sultana Ahmed,
Volume 15, Issue 6 (Special issue (Nov-Dec) 2021)
Abstract
Background and objectives: Turnaround time (TAT) is an important quality indicator for benchmarking laboratory performance. Delay in TAT may affect patient safety; thus, continuous monitoring and analysis of laboratory workflow is mandatory. This study was designed to improve the TAT of two biochemistry laboratories serving in tertiary care teaching hospitals (multispecialty and super-specialty) through the application of quality tools namely quality failure reporting, the Fishbone model, and process mapping.
Methods: First, TAT was defined for routine (four hours) and urgent samples (two hours). Then, TAT failureincidents in 2018-2019 were analyzed using the Fishbone model. The process map of TAT was studied and made more value streamed and lean after removal of waste steps.Corrective action plans were prioritized and implemented for potential causes with more adverse outcomes. Pilot solutions were implemented for six months and TAT failures incidents were reanalyzed.
Results: The quality failure in TAT reporting was reduced by 22% (from 34% to 12%) for urgent samples and by 19% (from 27% to 8%) for routine samples after the implementation of quality tools in multispecialty hospital laboratory. In the super-specialty hospital laboratory, the improvement was more profound and the TAT percentage achieved after the corrective actions was 96.57% and 98% for urgent and routine samples, respectively.
Conclusion: Implementation of quality failure reporting culture along with quality tools led to significant improvement in TAT and higher quality laboratory performance in terms of efficiency, reliability, and increased patient safety.
Antimicrobial susceptibility testing of colistin: Evaluation of standard broth microdilution method for gram-negative bacilli
Naila Begum , Amit Garg , Karvi Agarwal ,
Volume 19, Issue 5 (Sep-Oct 2025)
Abstract
Background: Colistin is regarded as the last resort for managing infections caused by multidrug-resistant (MDR) Gram-negative bacilli (GNB). The World Health Organization (WHO) includes colistin on its list of critically necessary antimicrobials. Minimum inhibitory concentrations (MICs) are used to monitor the development of colistin resistance. This study aimed to assess the performance of the Broth Microdilution Method (BMD) against routine Kirby-Bauer disk diffusion (KBDD) and automated BD Phoenix for the detection of the in vitro activity of colistin against GNB.
Methods: A cross-sectional study was conducted in the Department of Microbiology, LLRM Medical College, Meerut, Uttar Pradesh, from September 2023 to January 2024. The KBDD method, BMD method, and BD Phoenix (Becton Dickinson, USA) automated system were used to detect colistin susceptibility in 320 GNB isolated from various clinical samples. MIC determined by the BMD method was interpreted according to Clinical Laboratory Standards Institute (CLSI) 2023 guidelines.
Results: In our study, 320 isolates of GNB were identified from patients with a mean age of 45.34 years. A total of 320 isolates [145 (45.31%) Escherichia coli, 124 (38.75%) Klebsiella pneumoniae, 32 (10.0%) Pseudomonas aeruginosa, and 19 (5.93%) Acinetobacter baumannii complex] were tested simultaneously with all three methods for colistin susceptibility. The overall resistance to colistin among GNB was found to be 17.18% by the gold standard BMD method, 15.31% by BD Phoenix, and 14.37% by KBDD.
Conclusion: BMD is the most cost-effective, authentic method for routine testing of colistin susceptibility as compared to other methods. The comparative analysis revealed that BMD is superior to other methods in detecting colistin susceptibility, emphasizing its potential role in guiding clinicians in antibiotic therapy decisions.


OUTBREAK OF BURKHOLDERIA GLADIOLI: AN “ALARMING PERIL” CAUSING SEPTICEMIA IN NEONATAL INTENSIVE CARE UNIT: A RARE STUDY
Dr. Karvi Agarwal, Dr. Naila Begum, Dr. Konpal Agarwal,
Volume 20, Issue 2 (6-2026)
Abstract
OBJECTIVES:  To investigate the outbreak in the NICU of a tertiary care hospital in western UP in India and to know the source of infection by doing root cause analysis, study the clinical profiles and outcomes of neonates with Burkholderia gladioli septicemia, to determine the antimicrobial susceptibility pattern of these isolates and to take adequate CAPA.
METHODOLOGY: During the month of January 2024, multiple Burkholderia gladioli isolates with similar AST pattern were isolated from blood cultures of babies admitted to NICU of our hospital. An outbreak was suspected with mortality rate of 57.1%. The NICU in-charge and HIC team were alerted to follow up the patients and to investigate this outbreak for CAPA and RCA. Environmental Surveillance was done for NICU. Burkholderia gladioli was successfully isolated from suction apparatus and phototherapy units as confirmed by Automated BD Phoenix System.
RESULTS: Out of 72, 34 bottles signaled/flagged positive for microbial growth, with positivity rate of 47.2%. Among the positive cultures, Burkholderia gladioli were isolated from seven different patients, contributing to major percentage of 20.6% of total positivity. The Identification and Antimicrobial susceptibility testing were performed by Automated BD Phoenix system
CONCLUSION: This outbreak investigation raises the concern regarding the potential severity of Burkholderia gladioli septicemia in NICU set up and the need to broaden clinicians' suspicion for this rare bug. Rapid identification of the outbreak, defining the source and taking appropriate infection control measures to control the outbreak are the key points in managing and improving the neonatal outcome.
 
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