Delivering Purpose in PathologyDr Tom Lewis

Fran’s Story

What matters to patients

• To trust those providing their care  

• To feel cared for

• To know if they are normal, and if not, what needs to happen

"To enable citizens, and their carers, to make informed decisions about their care"

Points of leverage

• Clean In

• Clean Through

• Clean Out

Clean In

• Necessary

• Maximally appropriate

• Sufficient

Clean Through

• Without Error

• With known variation

• On time

Clean Out

• Understood

• Helpful

• Reflective of “what is normal for me”

When we follow this we see

• more purpose

• more capacity

• less cost

• less harm

The microbiology of urinary tract infection

Number of urine samples received from primary care

Edith’s Story

Clean In - Necessary?

Clinical details on request forms. 2010.

Acting on Clean In – Necessary

Acting on Clean In – Sufficient and maximally appropriate

We want to promote these We want to avoid

these

Acting on Clean ThroughWithout error and with known variation

Laboratory Accreditation??

ISO 15189???

Acting on Clean Through – On time

% specimens with clinically relevant antibiotic sensitivities released within 24 hours, including complex mixtures

Acting on Clean Out – helpful

Acting on Clean Out – “Normal for me”

Days with symptoms

Acting on Clean OutUnderstanding

Outcomes - Cost

Commissioning costs down by £200 000 pa

Consumable costs down by £20 000 pa

Absorbed loss of one biomedical scientist

Outcomes – mortality and admissions

Death following urinary sepsis lowest in region

Admissions with UTI stabilised having being rising at 10-20% pa

Outcomes – antibiotic stewardship

24% drop in UTI antibiotic prescribing

Now 13% below Devon average

Equates to 8600 prescriptions pa

Carbapenem use fallen by 50%