Church D L, Don-Joe C, Unger B
Departments of Pathology and Laboratory Medicine and Medicine, University of Calgary, Calgary, Alberta.
Arch Pathol Lab Med. 2000 Mar;124(3):357-61. doi: 10.5858/2000-124-0357-EOROTP.
To evaluate the error rates of organism identification and antibiotic susceptibility proficiency testing challenges before, during, and after microbiology laboratory restructuring in Alberta.
Alberta Health substantially reduced and redistributed laboratory funds to the regional health authorities in 1995, forcing a dramatic restructure of services. Many rural hospitals expanded their microbiology test menus, and urban centers consolidated microbiology testing into a centralized high-volume laboratory. The Laboratory Proficiency Testing Program of the College of Physicians and Surgeons of Alberta mailed regular test profile surveys to microbiology laboratories during the restructure period to determine the type and extent of changes in services. Based on the types of tests and the extent of analysis being done, most rural B-level and some C-level laboratories were reclassified to the A level. The Laboratory Proficiency Testing Program reviewed the error rates of proficiency challenges based on the performance of different levels of laboratories before and after the period of restructure.
Overall performance has improved according to the number of errors documented on identification and susceptibility challenges for laboratories that remained at the same classification (ie, A or C). The number of major identification errors for laboratories that were reclassified increased, but the rate of major susceptibility errors decreased. More reclassified laboratories do not have dedicated registered technologist(s) who perform microbiology testing and are not supervised by an on-site pathologist and/or medical microbiologist compared with laboratories that remained at the same classification.
Microbiology laboratory restructuring will have adverse effects on the quality of complex testing if experienced technologists are not retained and services are not medically supervised.
评估艾伯塔省微生物实验室重组前、重组期间和重组后的微生物鉴定错误率及抗生素敏感性能力验证挑战情况。
1995年，艾伯塔省卫生部大幅削减并重新分配了实验室资金给地区卫生当局，迫使服务进行大幅重组。许多农村医院扩大了微生物检测项目菜单，城市中心则将微生物检测整合到一个集中的大容量实验室。在重组期间，艾伯塔省医师和外科医生学院的实验室能力验证项目定期向微生物实验室邮寄测试概况调查，以确定服务变化的类型和程度。根据所进行的测试类型和分析程度，大多数农村B级和一些C级实验室被重新分类为A级。实验室能力验证项目根据重组前后不同级别实验室的表现，审查了能力验证挑战的错误率。
对于分类保持不变（即A级或C级）的实验室，根据鉴定和药敏挑战中记录的错误数量，总体表现有所改善。重新分类的实验室主要鉴定错误数量增加，但主要药敏错误率下降。与分类保持不变的实验室相比，更多重新分类的实验室没有专门进行微生物检测的注册技术人员，且没有现场病理学家和/或医学微生物学家的监督。
如果不保留经验丰富的技术人员且服务没有医学监督，微生物实验室重组将对复杂检测的质量产生不利影响。
