Identifying strengths and weaknesses at the bench, an institution’s quest to improve the Gram stain bench experience and patient care

Abstract Introduction/Objective The Gram stain is the first actionable result reported to guide treatment. In our laboratory, we noted instances of initial Gram stain results discrepant to subsequent cultures. In reevaluating the Gram stain bench, we devised a survey for medical laboratory scientists (MLS) to determine the strengths and weaknesses of the current workflow to search for areas of improvement. Results of the survey will help both leadership and MLS approach improving the interpretation and reporting of Gram stains. Methods/Case Report A 16-question survey was issued to all MLS in the microbiology lab over three weeks in January 2024 (Table 1). Questions (Q) 1 through 5 pertain to years of experience, how long it takes to review slides, and shift scheduling. Q6 through Q15 - addressing aspects of the bench including culture of the laboratory to ask for assistance, pressure to read slides, turnaround times, and confidence - were on a Likert scale from 1 to 5, 1 is strongly disagree and 5 is strongly agree; mean responses are in Table 1. Q16 was a free response question to input additional thoughts or comments. Responses were recorded on the secure local network using Microsoft Forms. Welch’s t-test was performed on the responses for statistical analysis. Statistical significance is achieved in a p-value is < 0.05. Results (if a Case Study enter NA) Among the 33 respondents (Table 1), first shift has the longest MLS work experience (Q2). Third shift perceived significantly more pressure to read Gram stains correctly than first shift (Q8 2.6; 4.6), and turnaround time pressure was felt to hinder their ability to read (Q11 2.1; 3.3). Individuals who perceived the field was too large for review also took more time to review slides (Q12 2.2; 3.0). Being staffed on the Gram stain bench less frequently was associated with taking longer to interpret Gram stains. Conclusion Our laboratory environment is, overall, conducive to asking for assistance, there is assistance when needed, there is confidence and allotted time to read stains, and there is perceived adequate training. However, the data indicate that second and third shifts are disproportionately comprised of MLS who read the most Gram stains, have the fewest years of experience, and are least inclined to ask for assistance. This information is invaluable for redesigning the Gram stain bench in a manner that benefits and empowers MLS to maximize their expertise to read Gram stains and provide the best care for patients. Further discussion is planned to redesign the workflow using this information.