Sautter Robert L, Thomson Richard B
Director of Microbiology and Point of Care, Carolinas Pathology Group, Carolinas HealthCare System, Charlotte, North Carolina, USA
NorthShore University HealthSystem, The University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
J Clin Microbiol. 2015 May;53(5):1467-72. doi: 10.1128/JCM.02569-14. Epub 2014 Sep 24.
The manner in which medical care is reimbursed in the United States has resulted in significant consolidation in the U.S. health care system. One of the consequences of this has been the development of centralized clinical microbiology laboratories that provide services to patients receiving care in multiple off-site, often remote, locations. Microbiology specimens are unique among clinical specimens in that optimal analysis may require the maintenance of viable organisms. Centralized laboratories may be located hours from patient care settings, and transport conditions need to be such that organism viability can be maintained under a variety of transport conditions. Further, since the provision of rapid results has been shown to enhance patient care, effective and timely means for generating and then reporting the results of clinical microbiology analyses must be in place. In addition, today, increasing numbers of patients are found to have infection caused by pathogens that were either very uncommon in the past or even completely unrecognized. As a result, infectious disease specialists, in particular, are more dependent than ever on access to high-quality diagnostic information from clinical microbiology laboratories. In this point-counterpoint discussion, Robert Sautter, who directs a Charlotte, NC, clinical microbiology laboratory that provides services for a 40-hospital system spread over 3 states in the southeastern United States explains how an integrated clinical microbiology laboratory service has been established in a multihospital system. Richard (Tom) Thomson of the NorthShore University HealthSystem in Evanston, IL, discusses some of the problems and pitfalls associated with large-scale laboratory consolidation.
美国医疗保健的报销方式导致了美国医疗保健系统的显著整合。这种整合的后果之一是出现了集中式临床微生物学实验室，这些实验室为在多个异地（通常是偏远地区）接受治疗的患者提供服务。微生物标本在临床标本中独具特色，因为最佳分析可能需要维持生物体的活性。集中式实验室可能距离患者护理场所数小时路程，运输条件需要确保在各种运输条件下都能维持生物体的活性。此外，由于提供快速结果已被证明可改善患者护理，因此必须具备有效且及时的方法来生成并报告临床微生物学分析结果。此外，如今越来越多的患者被发现感染了过去非常罕见甚至完全未被识别的病原体。因此，传染病专家尤其比以往任何时候都更依赖从临床微生物学实验室获取高质量的诊断信息。在这场针锋相对的讨论中，罗伯特·索特（Robert Sautter）负责北卡罗来纳州夏洛特市的一家临床微生物学实验室，该实验室为美国东南部三个州的40家医院系统提供服务，他解释了如何在多医院系统中建立综合临床微生物学实验室服务。伊利诺伊州埃文斯顿北岸大学医疗系统的理查德（汤姆）·汤姆森（Richard [Tom] Thomson）讨论了与大规模实验室整合相关的一些问题和陷阱。
