Department of Pediatrics, Division of Pediatric Infectious Diseases, SUNY Downstate Medical Center, Brooklyn, New York.
Department of Pathology, Division of Pediatric Infectious Diseases, SUNY Downstate Medical Center, Brooklyn, New York.
J Pediatric Infect Dis Soc. 2020 Jul 13;9(3):293-297. doi: 10.1093/jpids/piz019.
Outsourcing of microbiology laboratory services is a growing trend in US medical centers. Data on the actual impact of outsourcing on patient care, safety, and medical education, including costs, are limited. The objective of this study was to examine the published literature on the potential benefits and harms when medical centers outsource common microbiology services.
We conducted a 16-step literature search of PubMed and Embase. Articles were selected for full-text review if their content matched our key questions: (1) What are the potential benefits of outsourcing core microbiology laboratory testing? (2) What are the potential harms to patient care and medical education when medical centers outsource essential microbiology services?
The initial search yielded 6111 unique published articles; 36 were selected for full-text review, which resulted in the identification of 8 articles that addressed our key questions (2 editorials, 3 editorials with observational data, 1 survey, 1 case series, and 1 study of blood culture transport). These articles described a variety of issues, including longer turnaround times for blood cultures that resulted in delays in diagnosis and treatment, errors that resulted in patient morbidity, limited cost savings, and communication barriers.
In this study, with the exception of the blood culture transport study, we found no published prospective studies that quantified the effects of outsourcing microbiology services on patient care, patient safety, or medical education. However, these largely anecdotal reports suggest that outsourcing microbiology services may have a detrimental impact on medical education, especially infectious disease training programs.
微生物学实验室服务外包在美国医疗中心是一种日益增长的趋势。关于外包对患者护理、安全和医学教育（包括成本）的实际影响的数据有限。本研究的目的是研究已发表的关于医疗中心外包常见微生物服务的潜在益处和危害的文献。
我们对 PubMed 和 Embase 进行了 16 步的文献检索。如果文章内容符合我们的关键问题，将进行全文审查：（1）将核心微生物实验室检测外包有哪些潜在益处？（2）医疗中心将基本微生物服务外包时，对患者护理和医学教育有哪些潜在危害？
最初的搜索产生了 6111 篇独特的已发表文章；36 篇被选为全文审查，其中确定了 8 篇文章回答了我们的关键问题（2 篇社论、3 篇带有观察数据的社论、1 篇调查、1 篇血培养运输病例系列和 1 篇研究）。这些文章描述了各种问题，包括血培养的周转时间延长导致诊断和治疗延迟、导致患者发病的错误、有限的成本节约以及沟通障碍。
在这项研究中，除了血培养运输研究外，我们没有发现任何已发表的前瞻性研究量化了外包微生物服务对患者护理、患者安全或医学教育的影响。然而，这些主要是轶事报告表明，外包微生物服务可能对医学教育，特别是传染病培训项目产生不利影响。
