Microbiology laboratory consolidation at the National Reference Laboratory, United Arab Emirates: implementation, early outcomes, and lessons learned from a hub-and-spoke network redesign.

OBJECTIVES: This case study examines the planning, design, and initial post-implementation outcomes of a phased microbiology laboratory consolidation project within the National Reference Laboratory (NRL) network. The project sought to enhance operational efficiency; minimize inter-site variability; safeguard urgent diagnostic pathways; expand access to advanced microbiology resources; and eliminate unnecessary duplication of space, instrumentation, quality activities, and labor.

METHODS: The consolidation used a selective hub-and-spoke model, designating NRL Industrial City of Abu Dhabi as the reference center for routine, non-time-critical assays, whereas peripheral sites retained urgent and stability-dependent testing. The network comprises a central reference laboratory and two peripheral laboratories that serve our clients within the United Arab Emirates. The project encompassed service mapping, hub selection, workflow testing, risk assessment, laboratory information system validation, transport and readiness planning, phased implementation, and structured post-implementation refinement. Baseline workload and collection timing data informed staffing, courier scheduling, and the extent of centralization.

RESULTS: Urgent diagnostic pathways were maintained at existing testing sites, and standardization and governance were enhanced at all locations. Turnaround times improved across several routine culture workflows: the aggregate bacterial culture category decreased by 35.3% (P = 0.01) and methicillin-resistant Staphylococcus aureus screening by 13.3% (P = 0.04). The aggregate bacterial culture figure is an unweighted summary of the routine culture menu and is not weighted by individual test volume; test-level changes are reported separately in Figure 4. Urine culture contamination rates declined from 0.99% to 0.80% (P ≈ 0.045), whereas the median blood culture turnaround time remained stable at approximately 5 days. The estimated annual savings amounted to United Arab Emirates dirham 180,500, with a projected operational efficiency gain of one to two full-time equivalents.

CONCLUSION: Phased, selective hub-and-spoke consolidation enables the centralization of routine microbiology while preserving time-critical diagnostics. Contingent upon reliable transport, it protects urgent workflows, harmonizes standard operating procedures, validates laboratory information system routing, enables active stakeholder communication, and sustains governance from the outset.