Optimising BSI workflow

Bloodstream infections (BSIs) and sepsis are still a leading cause of mortality. There are an estimated 3.4 million Europeans affected by sepsis each year, representing one of the most expensive medical conditions for hospitals to treat. In fact, one study estimated an average cost of €22,800 (£20,255) per cases of severe sepsis in France.

On 1 March 2022 a team of experts came together to pilot the Clinical Workflow Optimisation Service (CWOS) for BSI in the Puerta de Hierro Majadahonda University hospital in Madrid. This article reports the customer feedback during the service execution early phases.

The BSI CWOS’s objectives are: to support the customer in improving the overall workflow by executing a performance assessment and identifying selected KPIs to monitor for evaluating the impact of an action plan, communicate and demonstrate the impact of the preanalytical and analytical intercorrelation and, finally, promoting the adoption of the BD BSI Solution.

The scope was to analyse and optimise the customer’s BSI workflow and to enhance the cooperation among nursing, the emergency department (ED) and the microbiology laboratory. To make this possible, the BD consultants have been working hand in hand with the

“We seek for our work to be as useful as possible for the patient, so the more efficient and effective our diagnostic method is, the better,” explains Isabel Sánchez Romero, a microbiology and parasitology specialist who has been working at Hospital Puerta de Hierro for the past 16 years.

The workflow optimisation service is divided into three phases:

• baseline lean assessment and recommendations
• team education
• ongoing coaching meetings and postlean assessment

The baseline lean assessment During the first phase, executed between the 1–4 March 2022, BD experts conducted a set of interviews and observations to evaluate potential critical aspects on site at the customer facilities. More than 40 samples have been tracked and seven observations of the pre-analytical phase were conducted in the ED.

The results of the analysis were presented in a report and the participants could learn about their performance in terms of adherence to best practices regarding: contamination, blood fill volume and time from collection to incubation.

“Knowing data is very important. For example, the data of the filling volume. People may not know that the blood culture vials are getting filled only by half. Knowing that we are failing, that this is happening here, is giving us very valuable information to improve. The problem on the blood fill volume is something I did not expect. I thought that we filled the blood culture vials properly,” explains Vanessa Martín, an emergency nurse that has worked at Hospital Puerta de Hierro since 2015.

The report was very well received by each one of the stakeholders, with a strong willingness to act on the data that had been newly discovered. The healthcare professionals requested BD’s support for escalating the performance issues to the hospital management.

“The points on which we cannot act should be transmitted in a more official way also to our managers. There is a part that we are not going to be able to fulfil because we do not have the means. We need at least to make our managers aware,” states Rosa Capilla, head of the emergency department.

The BD team was also recognised as a partner for BSI, the value of the findings were praised, and the customer is now looking forward to an end-to-end solution proposition that can help them solve the critical issues.

“The most valuable insight regards the fill volume metrics. I have found it vital. We could solve these problems with training and with new workflow designs and new proposals that BD can make us,” says Isabel Sánchez Romero, Microbiology and Parasitology Specialist.

Team training

During the second phase, executed on 21 and 22 June 2022, BD experts led a training on lean topics, fostering a close collaboration between the customer’s stakeholders from microbiology, ED, and nursing. The cross functional

cooperation was very appreciated by the customer and it was considered essential for enabling any improvement in the BSI pathway.

The primary objectives of the training were as follows:

• identifying the most relevant KPIs for the BSI diagnostic pathway (blood fill volume; contamination rate; time of collection to incubation and time from the Gram result to communication to clinician)
• providing the tools and the training to monitor the KPIs
• designing a tailored action plan (including BD products and services) to improve BSI metrics.

The healthcare professionals participating in the training recognised that they face several performance challenges in the BSI diagnostic and appreciated being able to have knowledge of what was really going on. The two team-education days were punctuated by various theoretical trainings, workshops, exercises. The testimonial and customer experience data collection for this phase of the service is under preparation and will be part of future communications.

Expected outcomes

The CWOS for BSI pilot allowed the BD experts to assess customer interest, collect feedback and, by the end of the activity, design an end-to-end solution aiming to improve the performance of the analysed scenario.

The customer’s stakeholders expect to be able to identify the weak points in their processes and to follow up on current and future performance by monitoring the KPIs such as the reduction of time to result of the specimen analysis (more specifically the time from collection to incubation) and the reduction of samples contamination rates. Further, they expect to become more efficient and to enable a more fluid communication between the ED and microbiology department.

“I would like to reduce the time until we have the result. If we manage to remove even a step only, from those that delay the proper treatment of a patient, it will be a success,” says Rosa Capilla, head of the emergency department after the pilot.

During a satisfaction survey regarding the activities conducted till now, the three stakeholders were fully satisfied with the content of the report provided and with skillsets demonstrated by the BD professionals. They will gladly recommend this service to other departments.

Phase three, the “Ongoing Coaching Meetings and Post Lean Assessment” started in mid-July, 2022. The phase is still in progress.