Evidence based diagnostic microbiology: has its time come?
- 1Centre for Health Informatics, University of New South Wales, Sydney 2052, Australia
- 2Centre for Infectious Diseases and Microbiology Laboratory Services, Institute of Clinical Pathology and Medical Research, Westmead Hospital, Westmead 2145, New South Wales, Australia vitalis@icpmr.wsahs.nsw.gov.au
The concept of evidence based practice (EBP) has evolved in response to technological advances and external pressure to increase efficiency and to contain the cost of health care.1 The ambitious aim of evidence based health care, and evidence based pathology in particular, is to advance clinical diagnosis and prognosis of disease through research and dissemination of new knowledge that meets high standards of critical review.2, 3 EBP requirements and principles have been reviewed elsewhere.2, 4 Importantly, the approaches to evidence based treatment are well established; however, evidence based diagnosis is much less developed. The purpose of this commentary is to outline the current status of EBP in diagnostic microbiology and to suggest some steps that pathologists can take to promote patient outcome oriented microbiology.
Emerging diagnostic challenges
Pathologists have been overwhelmed in recent years by the seemingly relentless growth of requirements to improve the effectiveness and efficiency of laboratory practice. In addition, the diagnostic microbiology market is becoming increasingly sensitive to costs and customer requirements. Cost cutting has a considerable negative effect on microbiology research and development. Adding fuel to this concern, there is an emerging view that pathology is a clinical service that has to adjust to the expectations of patients and health service providers. The focus of quality control has been shifting from zero defects to zero defections of referring physicians.
Diagnostic microbiology services are increasingly criticised for encouraging higher rates of testing without concomitant benefits. At the same time, in a recent systematic review of laboratory audits, 46% of microbiology diagnostic tests were found to be inappropriate.5 How often appropriate tests are not requested has not been studied systematically.5, 6
The role of the microbiology laboratory in the diagnosis of mild infections (acute bronchitis, urinary tract infections, community acquired pneumonia, etc) has …
