---

Background and objectives: Turnaround time (TAT) is an important quality indicator for benchmarking laboratory performance. Delay in TAT may affect patient safety; thus, continuous monitoring and analysis of laboratory workflow is mandatory. This study was designed to improve the TAT of two biochemistry laboratories serving in tertiary care teaching hospitals (multispecialty and super-specialty) through the application of quality tools namely quality failure reporting, the Fishbone model, and process mapping.
Methods: First, TAT was defined for routine (four hours) and urgent samples (two hours). Then, TAT failureincidents in 2018-2019 were analyzed using the Fishbone model. The process map of TAT was studied and made more value streamed and lean after removal of waste steps.Corrective action plans were prioritized and implemented for potential causes with more adverse outcomes. Pilot solutions were implemented for six months and TAT failures incidents were reanalyzed.
Results: The quality failure in TAT reporting was reduced by 22% (from 34% to 12%) for urgent samples and by 19% (from 27% to 8%) for routine samples after the implementation of quality tools in multispecialty hospital laboratory. In the super-specialty hospital laboratory, the improvement was more profound and the TAT percentage achieved after the corrective actions was 96.57% and 98% for urgent and routine samples, respectively.
Conclusion: Implementation of quality failure reporting culture along with quality tools led to significant improvement in TAT and higher quality laboratory performance in terms of efficiency, reliability, and increased patient safety.

---

Background and Objectives:Colistin is regarded as the final resort for managing infections caused by multi-drug resistance (MDR) gram-negative bacilli (GNB). Minimum inhibitory concentration (MIC) is used to monitor the development of colistin resistance. This study aimed to assess the performance of  Broth Microdilution Method (BMD) against routine Kirby-Bauer disk diffusion (KBDD) and automated BD Phoenix for the detection of in vitro activity of colistin against GNB
Methods: A cross-sectional study was done in the Department of Microbiology, LLRM Medical College, Meerut Uttar Pradesh from September 2023 to January 2024. KBDD method, BMD method  & BD Phoenix (Becton Dickinson, USA) automated system were used in 320 GNB isolated from various clinical samples to detect Colistin susceptibility. MIC determined by BMD method was interpreted according to  Clinical Laboratory Standards Institute (CLSI) 2023 guidelines.
Results: In our study,320 isolates of GNB were identified from the patients with a mean age of 45.34 years. A total of 320 isolates [145(45.31%) Escherichia coli, 124(38.75%) Klebsiella pneumoniae, 32(10.0%) Pseudomonas aeruginosa, and 19(5.93%) Acinetobacter baumannii complex] were tested simultaneously with all three methods for colistin susceptibility. The overall resistance to Colistin amongst GNB was found to be 17.18%  by the gold standard BMD method, 15.31% by BD Phoenix, and 14.37%  by KBDD.
Conclusion: BMD is the most cost-effective, authentic method for routine testing of colistin susceptibility as compared to other methods. The comparative analysis revealed that BMD is superior to other methods in detecting colistin susceptibility emphasizing its potential role in guiding clinicians for treatment decisions