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Quality improvement project to reduce beta-D-glucan turnaround times in an NHS pathology network

Summary

Hospitals were taking too long to get results for a fungal blood test (beta-D-glucan) that helps doctors decide whether patients with serious infections need antifungal medicines. A UK hospital pathology network improved this by bringing the test in-house instead of sending samples to a distant reference laboratory. After implementing the new system, they cut the average wait time from over 11 days to just 2.5 days while also saving money, allowing doctors to make faster treatment decisions for critically ill patients.

Background

Beta-D-glucan (BDG) is a fungal biomarker used to diagnose invasive fungal infections, particularly in haematological malignancy and critically ill patients. Long turnaround times (TATs) from reference laboratories limit the clinical utility of BDG testing for antifungal stewardship. In 2021, the South West London Pathology network experienced mean TATs exceeding 11 days, more than double the 5-working-day standard.

Objective

To improve BDG testing turnaround times by achieving at least 90% of results authorised within 5 working days of sample receipt. The project aimed to reduce mean TAT from 11.6 days to 5 days or less while maintaining or reducing unit costs.

Results

Implementation of in-house BDG testing (PDSA C2) achieved the primary outcome of 92.8% of results authorised within 5 working days, improving from 0.88% baseline. Mean TAT reduced from 11.6 days to 2.5 days, and unit cost decreased from £81.13 to £67.14 per test, saving approximately £17,000 annually. Sample rejection rates fell from 11% to 0%.

Conclusion

In-house BDG testing using a commercially available assay successfully improved turnaround times, reduced costs, and enhanced antifungal stewardship capability. The project demonstrates that quality improvement can be limited by external systems, but local adoption of technological innovations can circumvent these barriers. Ongoing work includes optimising galactomannan testing and investigating the impact on antifungal prescribing.
  • Published in:BMJ Open Quality,
  • Study Type:Quality Improvement Project,
  • Source: 10.1136/bmjoq-2024-003210, PMID: 40328642
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