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32 Implementation of an online microbiology referral pathway in a hospital trust – a quality improvement report
  1. Kim Pramanik1,
  2. Sandra Long2
  1. 1University Hospitals Leicester, Infirmary Square, Leicester, UK, LE1 5WW
  2. 2Royal Blackburn Hospital, Haslingden Road, Blackburn, UK, BB2 3HH


Aims Appropriate diagnostic and antimicrobial stewardship relies on national and local data on antimicrobial resistance patterns unique to every region. Adaptive problems such as variability in the quality of information provided for antimicrobial guidance, inefficiency of a phoned referral system and reduced compliance with Royal College of Pathologists key performance indicator 6.3 of response to urgent referrals within one hour mandated a microbiologist-led change of referral method and content to improve assessment and management of a suspected infectious disease.

Methods A measurement plan comprising parameters quantifying the problems associated with phoned referrals was used over two plan do study act (PDSA) cycles. Approximately 25 patients were sampled randomly for urgent and non-urgent referrals during 2020 and 2021 using online consultation records. Interventions for this project were an online non-urgent referral pathway using existing trust-approved software rolled out for over four million patients, and online communications disseminated trust-wide to all clinicians for awareness and engagement. Feedback was sought in a third PDSA cycle using a survey via trust email, enabling sampling of clinician impressions.

Results Compliance improved in all parameters, repeat calls were prevented on re-assessment, and non-urgent referral information quality increased to 100% from 24%. Survey results (n=19) revealed that 89% preferred the online referral method, though increased awareness of the pathway was needed.

Conclusions Continued use would improve efficiency and transparency of communication, documentation and enable data collection for governance. Implementation of further PDSA cycles could promote sustainability and eventually reduce the risk of antimicrobial resistance. Future plans are in place to expand the clinician base to general practitioners within the region.


  • ‘QI’ ‘microbiology’ ‘stewardship’

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