Outsourcing Microbiology Services in Medical Centers: Is It Worth It?

Abstract

Background Outsourcing of microbiology laboratory services is a growing trend in US medical centers. Data on the actual impact of outsourcing on patient care, safety, and medical education, including costs, are limited. The objective of this study was to examine the published literature on the potential benefits and harms when medical centers outsource common microbiology services. Methods We conducted a 16-step literature search of PubMed and Embase. Articles were selected for full-text review if their content matched our key questions: (1) What are the potential benefits of outsourcing core microbiology laboratory testing? (2) What are the potential harms to patient care and medical education when medical centers outsource essential microbiology services? Results The initial search yielded 6111 unique published articles; 36 were selected for full-text review, which resulted in the identification of 8 articles that addressed our key questions (2 editorials, 3 editorials with observational data, 1 survey, 1 case series, and 1 study of blood culture transport). These articles described a variety of issues, including longer turnaround times for blood cultures that resulted in delays in diagnosis and treatment, errors that resulted in patient morbidity, limited cost savings, and communication barriers. Conclusions In this study, with the exception of the blood culture transport study, we found no published prospective studies that quantified the effects of outsourcing microbiology services on patient care, patient safety, or medical education. However, these largely anecdotal reports suggest that outsourcing microbiology services may have a detrimental impact on medical education, especially infectious disease training programs.

The High Stakes of Outsourcing in Health Care

“…5,53 More than 85% of infectious disease physicians report that having laboratory services onsite is crucial for timely diagnosis, care coordination, and communication with clinical microbiologists. 54 In a prospective study on the use of blood cultures, hospitals with offsite lab services experienced significantly longer transport times and total detection times for the presence of 12 different species of sepsiscausing bacteria and yeasts. 55 A study reporting interviews with 17 pathology department chairs at US academic medical centers revealed that the institutions that entered into joint ventures with lab service providers experienced unplanned, sizable cost increases over time, even though the primary reason for initiating the venture was financial.…”

Exposure of Public Sector with the Quasi-Market Through Outsourcing: A Case Study in Iran

“…Generally, the conducted researches show that although various models exist to outsource services however, this capacity has not been fully utilized and in most cases one or two models have been considered by policy makers and managers. Low motivation and tendency of managers, lack of complete understanding of outsourcing philosophy, unfamiliarity of managers with common outsourcing models, unsuccessful experiences of outsourcing, lack of eligible private provider and weakness in law and regulation are factors that have hindered outsourcing expansion (Mujasi & Nkosi, 2019;Penton et al, 2020;Shaarbafchizadeh et al, 2020).…”

Exposure of Public Sector with the Quasi-market Through Outsourcing: A Case Study in Iran

“…Given this, the public sector could improve the efficiency and quality of delivered services due to exposure to a competitive condition. The more competitive a market is, the higher the efficiency and quality of services will be (6)(7)(8)(9)(10)(11).…”