Experiences with community core clinical microbiology laboratories: Practices and models that work and those that don't

For the last several years, most clinical microbiologists have heard, talked, and thought about; have been threatened with; or have actually experienced the consolidation of clinical microbiology (CM) services. We present (i) concepts, experiences, and practices that we and others have found to be successful during the operation of consolidated CM laboratories, (ii) practices that were disappointingly unsuccessful, (iii) seven decisions that can increase the chances of maintaining high-quality CM services after consolidation, and (iv) studies performed to evaluate and compare the results of practical clinical microbiology testing performed at core laboratories and those performed at associated rapid response (i.e., stat, on-site, in-house, or primary) laboratories. If culture protocols are optimized for efficiency and clinical relevance, and if appropriately experienced personnel staff the core laboratory, the laboratory can provide CM services that meet or exceed those currently provided by the in-house laboratory of the local facility or hospital.