{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T02:14:41Z","timestamp":1785204881568,"version":"3.55.0"},"reference-count":33,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2025,3,22]],"date-time":"2025-03-22T00:00:00Z","timestamp":1742601600000},"content-version":"unspecified","delay-in-days":80,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"NHS England HSST Training Budget","award":["Fenella Halstead\u2019s annual training budget"],"award-info":[{"award-number":["Fenella Halstead\u2019s annual training budget"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open Qual"],"accepted":{"date-parts":[[2025,3,2]]},"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:p>Sepsis is a medical emergency caused by bacteria in the bloodstream and a dysregulated immune response. It is important to identify the bacteria rapidly so that the patient receives effective antibiotics. Delays are associated with higher mortality levels and poorer clinical outcomes.<\/jats:p>\n               <jats:p>Guidance requires full bacterial identification (ID) from bottle flagging positive, within 48 hours with older technology and 24 hours with modern platforms. Before this quality improvement project, we were using old technology including Analytical Profile Index (API) biochemical tests. Analysis highlighted very poor performance (mean 60 hours to ID), resulting in limited clinical utility and clinical incidents. There was great frustration among laboratory and clinical staff.<\/jats:p>\n               <jats:p>This project aimed to reduce the time taken to obtain ID for positive blood cultures to meet the guidance within 6\u2009months. Analysis led to a business case which helped secure funding for new equipment: a Matrix Assisted Laser Desorption Ionisation (MALDI) platform, to replace the time-consuming API process. MALDI uses time-of-flight mass spectrometry producing rapid ID of bacteria in minutes, indirectly (from agar plate colonies) or directly from blood.<\/jats:p>\n               <jats:p>MALDI was introduced through two Plan-Do-Study-Act cycles, first with indirect analysis, then with direct. This spread the scientific staff training burden. The new process has dramatically reduced the mean time from flagging to pathogen ID to an average of 10.2\u2009hours, and availability of ID within 24 hours has improved from 0% to 95%.<\/jats:p>\n               <jats:p>We identified other change ideas for improvement (increasing staff availability and new technology for later stages), but these were parked due to time and funding pressures.<\/jats:p>\n               <jats:p>Although there remain limitations (especially in terms of staffing hours and the onward communication of the ID result), the MALDI platform has revolutionised the sepsis service we can provide, so represents a substantial improvement in the quality of care that our patients can receive.<\/jats:p>","DOI":"10.1136\/bmjoq-2024-003153","type":"journal-article","created":{"date-parts":[[2025,3,22]],"date-time":"2025-03-22T08:06:27Z","timestamp":1742630787000},"page":"e003153","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Reducing laboratory delays in blood culture pathogen identification: a quality improvement project"],"prefix":"10.1136","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2833-2926","authenticated-orcid":false,"given":"Fenella D","family":"Halstead","sequence":"first","affiliation":[{"name":"Medical Microbiology, Wye Valley NHS Trust, Hereford, UK"},{"name":"Alliance Manchester Business School, The University of Manchester, Manchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-6471-1093","authenticated-orcid":false,"given":"Goran","family":"Pinjuh","sequence":"additional","affiliation":[{"name":"Medical Microbiology, Wye Valley NHS Trust, Hereford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7742-8003","authenticated-orcid":false,"given":"Grazia","family":"Antonacci","sequence":"additional","affiliation":[{"name":"Department of Primary Care and Public Health, NIHR ARC NWL, Centre for Health Economics & Policy Innovation, Imperial College London, Imperial College Business School, London, UK"},{"name":"Business School, Centre for Health Economics and Policy Innovation (CHEPI), Imperial College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1176-8088","authenticated-orcid":false,"given":"Nathan","family":"Proudlove","sequence":"additional","affiliation":[{"name":"Alliance Manchester Business School, The University of Manchester, Manchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,3,22]]},"reference":[{"key":"2025083114241626000_14.1.e003153.1","doi-asserted-by":"crossref","DOI":"10.1136\/bmjquality.u202548.w1443","article-title":"Improving time to antibiotics and implementing the \u201cSepsis 6\u201d","volume":"2","author":"McGregor","year":"2014","journal-title":"BMJ Qual Improv Rep"},{"key":"2025083114241626000_14.1.e003153.2","unstructured":"Weinbren M , Tilley R , Daniels R , et al . Clinical Toolkit 8: Laboratory handling and reporting of blood cultures [Internet]. UK Sepsis Trust. 2018. Available: https:\/\/sepsistrust.org\/wp-content\/uploads\/2018\/06\/BC-toolkit-final-Sept15.pdf"},{"key":"2025083114241626000_14.1.e003153.3","unstructured":"UKHSA . SMI B37 Investigation of blood cultures (for organisms other than Mycobacterium species) (UK Standards for Microbiology Investigations). 2019. Available: https:\/\/assets.publishing.service.gov.uk\/media\/608199b3d3bf7f0132941970\/B_37i8.2.pdf"},{"key":"2025083114241626000_14.1.e003153.4","unstructured":"Langley GJ , Moen R , Nolan K , et al . The improvement guide: a practical approach to enhancing organizational performance. 2nd edn. San Francisco: Jossey-Bass, 2009:490."},{"key":"2025083114241626000_14.1.e003153.5","doi-asserted-by":"crossref","unstructured":"Elkhuizen S , Proudlove N . Chapter 6: improvement approaches. In: Vissers J , Elkhuizen S , Proudlove N , eds. Operations management for healthcare. 2nd edn. Routledge: Abingdon, UK, 2023: 123\u201341.","DOI":"10.4324\/9781003020011-7"},{"key":"2025083114241626000_14.1.e003153.6","doi-asserted-by":"crossref","DOI":"10.1136\/bmjoq-2021-001396","article-title":"Making every drop count: reducing wastage of a novel blood component for transfusion of trauma patients","volume":"10","author":"McCullagh","year":"2021","journal-title":"BMJ Open Qual"},{"key":"2025083114241626000_14.1.e003153.7","doi-asserted-by":"crossref","DOI":"10.1136\/bmjoq-2021-001538","article-title":"Improving turnaround times for HLA-B*27 and HLA-B*57:01 gene testing: a Barts Health NHS Trust quality improvement project","volume":"10","author":"White","year":"2021","journal-title":"BMJ Open Qual"},{"key":"2025083114241626000_14.1.e003153.8","doi-asserted-by":"crossref","DOI":"10.1136\/bmjoq-2022-001814","article-title":"Improving the turnaround times of infectious disease markers reporting in an NHS stem cell department","volume":"11","author":"Li","year":"2022","journal-title":"BMJ Open Qual"},{"key":"2025083114241626000_14.1.e003153.9","doi-asserted-by":"crossref","DOI":"10.1136\/bmjoq-2021-001605","article-title":"Summarised, verified and accessible: improving clinical information management for potential haematopoietic stem cell transplantation patients","volume":"10","author":"May","year":"2021","journal-title":"BMJ Open Qual"},{"key":"2025083114241626000_14.1.e003153.10","doi-asserted-by":"crossref","DOI":"10.1136\/bmjoq-2022-002221","article-title":"Reducing first appointment delays for electron radiotherapy patients by improving the treatment planning pathway: a quality improvement project","volume":"12","author":"Gately","year":"2023","journal-title":"BMJ Open Qual"},{"key":"2025083114241626000_14.1.e003153.11","doi-asserted-by":"crossref","DOI":"10.1136\/bmjoq-2021-001808","article-title":"Getting going on time: reducing neurophysiology set-up times in order to contribute to improving surgery start and finish times","volume":"11","author":"Pridgeon","year":"2022","journal-title":"BMJ Open Qual"},{"key":"2025083114241626000_14.1.e003153.12","doi-asserted-by":"crossref","DOI":"10.1136\/bmjoq-2023-002492","article-title":"Time is a terrible thing to waste: optimising use of intraoperative monitoring practitioner time towards maximising in-house IOM service provision and reducing spend on external provision","volume":"13","author":"Lodwick","year":"2024","journal-title":"BMJ Open Qual"},{"key":"2025083114241626000_14.1.e003153.13","doi-asserted-by":"crossref","DOI":"10.1136\/bmjoq-2023-002268","article-title":"Clinical-scientist-led transoesophageal echocardiography (TOE): using extended roles to improve the service","volume":"12","author":"Kaye","year":"2023","journal-title":"BMJ Open Qual"},{"key":"2025083114241626000_14.1.e003153.14","doi-asserted-by":"crossref","DOI":"10.1136\/bmjoq-2023-002317","article-title":"Time to be more efficient: reducing wasted transthoracic echocardiography (TTE) diagnostic appointment slots at Guy\u2019s and St Thomas\u2019 NHS Trust","volume":"12","author":"Freitas","year":"2023","journal-title":"BMJ Open Qual"},{"key":"2025083114241626000_14.1.e003153.15","first-page":"36","article-title":"What\u2019s your theory? Driver diagram serves as tool for building and testing theories for improvement","volume":"48","author":"Bennett","year":"2015","journal-title":"Qual Prog"},{"key":"2025083114241626000_14.1.e003153.16","unstructured":"Daniels R , Nutbeam T . The sepsis manual 6th edition [Internet]. United Kingdom Sepsis Trust, 2022. Available: https:\/\/sepsistrust.org\/wp-content\/uploads\/2022\/06\/Sepsis-Manual-Sixth-Edition.pdf"},{"key":"2025083114241626000_14.1.e003153.17","doi-asserted-by":"publisher","DOI":"10.1097\/01.CCM.0000217961.75225.E9"},{"key":"2025083114241626000_14.1.e003153.18","unstructured":"Daniels R , Nutbeam T . The sepsis manual 7th edition [internet]. United Kingdom Sepsis Trust. 2024 Available: https:\/\/sepsistrust.org\/wp-content\/uploads\/2024\/07\/Sepsis-Manual-7th-Edition-2024-V1.0.pdf"},{"key":"2025083114241626000_14.1.e003153.19","doi-asserted-by":"publisher","DOI":"10.1373\/clinchem.2012.198218"},{"key":"2025083114241626000_14.1.e003153.20","doi-asserted-by":"publisher","DOI":"10.1016\/j.cmi.2016.08.009"},{"key":"2025083114241626000_14.1.e003153.21","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0169332","article-title":"The Clinical Impact of Rapid, Direct MALDI-ToF Identification of Bacteria from Positive Blood Cultures","volume":"11","author":"French","year":"2016","journal-title":"PLoS One"},{"key":"2025083114241626000_14.1.e003153.22","doi-asserted-by":"publisher","DOI":"10.1177\/0951484818770411"},{"key":"2025083114241626000_14.1.e003153.23","doi-asserted-by":"crossref","DOI":"10.1186\/s12913-021-06254-1","article-title":"Process mapping in healthcare: a systematic review","volume":"21","author":"Antonacci","year":"2021","journal-title":"BMC Health Serv Res"},{"key":"2025083114241626000_14.1.e003153.24","unstructured":"National School of Healthcare Science . Higher specialist scientist training programme. 2024. Available: https:\/\/nshcs.hee.nhs.uk\/programmes\/hsst\/"},{"key":"2025083114241626000_14.1.e003153.25","doi-asserted-by":"crossref","unstructured":"Mohammed MA . Statistical process control. Cambridge: THIS Institute, University of Cambridge, 2024.","DOI":"10.1017\/9781009326834"},{"key":"2025083114241626000_14.1.e003153.26","unstructured":"Provost LP , Murray SK . The health care data guide: learning from data for improvement. 2nd edn. Hoboken, NJ: John Wiley & Sons, Inc, 2022."},{"key":"2025083114241626000_14.1.e003153.27","unstructured":"NHS England . Statistical process control tool [internet]. 2024. Available: https:\/\/www.england.nhs.uk\/statistical-process-control-tool\/"},{"key":"2025083114241626000_14.1.e003153.28","unstructured":"Dodds S . The 4N chart - Nuggets\/Niggles\/NiceIfs\/NoNos [Internet]. The Health Foundation: The Q Community, 2018. Available: https:\/\/q.health.org.uk\/document\/the-4n-chart-nuggets-niggles-niceifs-nonos\/"},{"key":"2025083114241626000_14.1.e003153.29","doi-asserted-by":"crossref","first-page":"419","DOI":"10.4103\/0255-0857.142261","article-title":"Use of MALDI-TOF MS technique for rapid identification of bacteria from positive blood cultures","volume":"32","author":"Hong","year":"2014","journal-title":"Indian J Med Microbiol"},{"key":"2025083114241626000_14.1.e003153.30","doi-asserted-by":"crossref","DOI":"10.3892\/br.2022.1530","article-title":"Rapid identification of Gram-negative pathogens from positive blood cultures using MALDI-TOF MS following short-term incubation on solid media","volume":"16","author":"Neonakis","year":"2022","journal-title":"Biomed Rep"},{"key":"2025083114241626000_14.1.e003153.31","doi-asserted-by":"crossref","DOI":"10.1186\/s12941-020-00403-w","article-title":"Evaluation of Rapid Sepsityper\u00ae protocol and specific MBT-Sepsityper module (Bruker Daltonics) for the rapid diagnosis of bacteremia and fungemia by MALDI-TOF-MS","volume":"19","author":"Ponderand","year":"2020","journal-title":"Ann Clin Microbiol Antimicrob"},{"key":"2025083114241626000_14.1.e003153.32","doi-asserted-by":"crossref","first-page":"1398","DOI":"10.1099\/jmm.0.001268","article-title":"Rapid Sepsityper in clinical routine: 2 years\u2019 successful experience","volume":"69","author":"Cordovana","year":"2020","journal-title":"J Med Microbiol"},{"key":"2025083114241626000_14.1.e003153.33","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0023285","article-title":"Identification of bacteria in blood culture broths using matrix-assisted laser desorption-ionization Sepsityper\u2122 and time of flight mass spectrometry","volume":"6","author":"Kok","year":"2011","journal-title":"PLoS One"}],"container-title":["BMJ Open Quality"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjoq-2024-003153","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,31]],"date-time":"2025-08-31T21:24:24Z","timestamp":1756675464000},"score":1,"resource":{"primary":{"URL":"https:\/\/qir.bmj.com\/lookup\/doi\/10.1136\/bmjoq-2024-003153"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1]]},"references-count":33,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,3,22]]},"published-print":{"date-parts":[[2025,1]]}},"alternative-id":["10.1136\/bmjoq-2024-003153"],"URL":"https:\/\/doi.org\/10.1136\/bmjoq-2024-003153","relation":{},"ISSN":["2399-6641"],"issn-type":[{"value":"2399-6641","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1]]}}}