{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T13:03:28Z","timestamp":1789563808765,"version":"build-2803163510"},"reference-count":8,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T00:00:00Z","timestamp":1789516800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Clinical microbiology culture interpretation depends on accurate specimen context, including specimen type, anatomic source, and collection method. However, electronic ordering systems often permit nonspecific culture orders that do not capture the information needed for appropriate processing, reporting, and result interpretation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We performed a quality improvement intervention at an academic tertiary care center to replace a generic \u201caerobic culture\u201d order with specimen-specific wound, sterile body fluid, and tissue\/biopsy culture orders linked to required specimen type and anatomic source fields. Ordering pathways were harmonized across procedural and nonprocedural work flows, and available tests were constrained based on the selected specimen type and source.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Before intervention, 1115 of 2528 eligible culture orders required laboratory cancellation and reordering, compared with 78 of 508 eligible orders after implementation, 44.1% vs 15.4%, risk ratio 0.35, 95% CI 0.28\u20130.43, P &amp;lt; 0.001. Generic aerobic culture ordering declined to zero 5 months after residual ordering pathways were identified and corrected. Remaining errors were largely attributable to retained preference-list orders, previously placed future or standing orders, and gaps in clinician education.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Specimen-specific microbiology order design reduced preanalytical ordering error and laboratory rework. These findings support microbiology order architecture as a practical diagnostic stewardship strategy that can improve specimen-context capture, reduce downstream laboratory correction, and better align culture ordering with laboratory processing requirements.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/jalm\/jfag140","type":"journal-article","created":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T11:47:32Z","timestamp":1787140052000},"source":"Crossref","is-referenced-by-count":0,"title":["Redesigning Microbiology Order Architecture to Improve Laboratory Efficiency"],"prefix":"10.1093","author":[{"given":"Justin","family":"McCallum","sequence":"first","affiliation":[{"name":"Department of Pathology and Laboratory Medicine, Tufts Medical Center , Boston, MA ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lance","family":"Harlan","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine, Tufts Medical Center , Boston, MA ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beverley","family":"Orr","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine, Tufts Medical Center , Boston, MA ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen","family":"Krajewski","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine, Tufts Medical Center , Boston, MA ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eliezer","family":"Nussbaum","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine, Tufts Medical Center , Boston, MA ,","place":["United States"]},{"name":"Department of Geographic Medicine and Infectious Diseases, Tufts Medical Center , Boston, MA ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sankha","family":"Basu","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine, Brigham and Women\u2019s Hospital , Boston, MA ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2931-3660","authenticated-orcid":false,"given":"Zoe Freeman","family":"Weiss","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine, Tufts Medical Center , Boston, MA ,","place":["United States"]},{"name":"Department of Geographic Medicine and Infectious Diseases, Tufts Medical Center , Boston, MA ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,9,16]]},"reference":[{"key":"2026091608093331600_jfag140-B1","first-page":"7","article-title":"Diagnostic errors and laboratory medicine\u2014causes and strategies","volume":"26","author":"Plebani","year":"2015","journal-title":"EJIFCC"},{"key":"2026091608093331600_jfag140-B2","doi-asserted-by":"crossref","first-page":"569","DOI":"10.1055\/a-2546-5868","article-title":"Optimizing wound culture ordering in electronic health records: a case report","volume":"16","author":"Hanna","year":"2025","journal-title":"Appl Clin Inform"},{"key":"2026091608093331600_jfag140-B3","first-page":"79","article-title":"Computerised order entry systems and pathology services\u2013a synthesis of the evidence","volume":"27","author":"Georgiou","year":"2006","journal-title":"Clin Biochem Rev"},{"key":"2026091608093331600_jfag140-B4","doi-asserted-by":"crossref","DOI":"10.1016\/j.jpi.2025.100459","article-title":"Data migration, validation and implementation of a new laboratory information system (LIS) in an academic pathology department, using Ellkay data archive, and Epic Beaker anatomic and clinical pathology 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center","volume":"8","author":"Blau","year":"2017","journal-title":"J Pathol Inform"},{"key":"2026091608093331600_jfag140-B8","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1038\/s41746-020-0221-y","article-title":"An overview of clinical decision support systems: benefits, risks, and strategies for success","volume":"3","author":"Sutton","year":"2020","journal-title":"NPJ Digit Med"}],"container-title":["The Journal of Applied Laboratory Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/jalm\/advance-article-pdf\/doi\/10.1093\/jalm\/jfag140\/71122369\/jfag140.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jalm\/advance-article-pdf\/doi\/10.1093\/jalm\/jfag140\/71122369\/jfag140.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T12:09:37Z","timestamp":1789560577000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jalm\/advance-article\/doi\/10.1093\/jalm\/jfag140\/8802002"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,16]]},"references-count":8,"URL":"https:\/\/doi.org\/10.1093\/jalm\/jfag140","relation":{},"ISSN":["2475-7241"],"issn-type":[{"value":"2475-7241","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,16]]},"article-number":"jfag140"}}