To our knowledge, this is the first region-wide survey study to examine the management situation of submitting specimens to a microbiology laboratory for inspection before use of antimicrobial. We explored the influencing factors based on the perspective of management and focused on the effect in different level of management factors. This study described the management status of the departments involved in the process of PP, and found that different departments have different degrees and effects of management and support related to PP and there was a significant difference in the PP between secondary and tertiary hospitals.
The inspection department has fewer performance appraisals related to PP. The pre- and post- analysis phases were considered to be the stage with high incidence of laboratory inspection errors and lack of attention. Researchers emphasized that it is necessary to improve the laboratory personnel's attention to the sample quality in the PP and the interpretation and feedback of the results after analysis, but the specific intervention measures are not clear[9, 16]. Training and publicity were among the management measures related to PP implemented by most hospitals, but the frequency was not high; in addition, different frequencies had different effects. AST usually focus on education interventions in many countries [17, 18]. Studies on improving the quality of hospital infection prevention and control have proposed to strengthen training, publicity and performance appraisal [19, 20]. However, our research found that different frequencies of training, performance appraisal and publicity have different effects on the quality of PP, and also have different effects in different departments. Our results showed that the training of clinicians had a significant impact on improving PP, which is consistent with previous studies . For the specimen collection department, it can be seen that providing a standard operation guide and training is very important to reduce errors in the collection process, and our results were in line with previous studies. At the same time, we are also concerned that the improvement of collection equipment and technology is also an urgent need to improve the quality of PP. It is suggested that hospital managers need to pay attention to what is the real management demand to improve the inspection work, and the technical and awareness intervention measures of different departments related to the inspection should be different in terms of methods and degrees. For the transportation department, we found that due to a lack of clear regulations regarding the establishment and ownership of the department, many hospitals lack targeted supervision systems. The problems in specimen transport were not resolved in time, which became the most easily neglected link affecting the quality of PP. For the inspection department, inspectors’ feedback on the quality of specimens collection and transportation and the guidance of doctors on temporary prescriptions can reduce the errors of inspection results. However, few laboratory communicate with clinical or other departments in the PP.
Although the request rates of different types of antimicrobial basically met the requirements, we found that there were differences between different levels of hospitals, and the impact of management factors on them was different. Understanding the specific impact of management factors on different types of antimicrobial in PP will help us better improve the quality of inspection. Different from the other two types of antimicrobial, only low-frequency performance appraisal has a significant impact on non restricted-use antimicrobial. Non restricted-use antimicrobial were usually provided in empirical drug use schemes, and the demand for microbiological test results is not very necessary, so the management requirements are relatively loose. This finding suggests that for most clinicians, an overly frequent review regime may be detrimental to the promotion of PP on non-restricted antimicrobial. Some studies have noted that employees' perceptions of fairness in performance appraisal also impact employee performance, including perceptions of the rationality of the evaluation cycle. In addition, the rationality of performance evaluation content for different levels of employees also affects their performance. We also found that the hospital's publicity activities on clinicians did not have a positive impact, and even had a negative impact in collection department and transportation Department. It is understood that the PP publicity in the survey area is usually distributed in the form of brochures. This single form is mostly considered ineffective.
In addition, we found the positive impact of information technology on improving the quality of PP. Many studies have proposed that the first way to improve the nursing quality and safety of inpatients is to use a well-designed information system to prevent and manage laboratory errors, and promote the continuous exchange of information among doctors, nurses and laboratory experts [23, 24]. Our results are consistent with them. Compared with regular education and training, information system can provide more timely decision-making guidance. A study from Portugal showed that good communication between doctors and microbiology laboratories should be considered a priority for any ASP . Efforts should be made to improve data sharing between doctors and microbiological laboratories, such as the provision of antibiotic prescription guidelines suitable for local hospital epidemiology, and easy access to hospital antibiotic sensitivity models and epidemiological databases. Multiple Department roles are designed in the inspection process. Good communication can reduce the risk of errors before laboratory analysis. As a timely tool, information technology can promote multi-party information sharing and communication. However, at present, in most of the tertiary and all secondary medical institutions, there is no perfect information system to support the inspection, and the functional requirements of the information system need to be further collected in various departments.
A limitation of the study was that the content of the survey was not comprehensive enough. This could have introduced some bias and omit some possible influencing factors, however the relatively professionals involved in the management of inspection request, providing advice from real practice for survey item, could have reduced this risk. The distribution of the survey may be another limitation. The number of departments surveyed was limited and may not be representative of the wider hospital in this country. Since our survey is the first baseline survey in China, the selected hospitals in a central province are enough to reflect the current average level of examination.