Rationalisation of Legionella Urinary Antigen Testing.
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Introduction: Legionnaires’ is a severe pneumonia, the diagnosis of which can be confirmed by a positive Legionella Urinary Antigen (LUA) test. The British Thoracic Society has specific guidelines for its use. Incorrect LUA test requests can result in false-positive results while accumulating costs.
Aims and Objectives: The aim is the rationalisation of LUA testing. The first objective is to educate clinicians on indications for testing reducing unnecessary orders. The second is to develop a laboratory Standard Operating Procedure (SOP) to screen test requests. The third is to reduce costs.
Methodology: Rationalisation of laboratory testing can be through clinical education, laboratory administrative methods or a combination. The HSE Model guided the change process. A pre-change audit created urgency, engaged key stakeholders and informed development of the SOP. Face-toface education was undertaken in H1 & H3, with a written memo distributed to H2. The new SOP was presented to laboratory staff. Post-change audit results were used to mainstream.
Evaluation: Following change implementation there was a decrease in LUA test requests in H1 & H3 of 17.5% and 15% respectively, but an increase of 2.3% overall. The total reduction in tests processed was 71.5% reducing costs by €2,195.52 and saving 24 hours of laboratory time.
Conclusion and Organisational Impact: Face-to-face educational interventions are beneficial however administrative methods are most effective when rationalising laboratory test usage. High level management support and early engagement of stakeholders is key in successful change. Once mainstreamed, a saving of €28,541 and 312 laboratory hours per annum is predicted.