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 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 employed a selective hub-and-spoke model, designating NRL-ICAD as the reference center for routine, non-time-critical assays, while peripheral sites retained urgent and stability-dependent testing. The network comprises a central reference laboratory and two peripheral laboratories serving our clients within the United Arab Emirates. The project encompassed service mapping, hub selection, workflow testing, risk assessment, laboratory information system (LIS) 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 both standardization and governance were enhanced at all locations. Turnaround time improved across several routine culture workflows: the aggregate bacterial culture category fell by 35.3% (p=0.01) and MRSA 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), while median blood culture turnaround time remained stable at approximately five days. Estimated annual savings amounted to AED 180,500, with a projected operational efficiency gain of one to two full-time equivalents. Conclusions Phased, selective hub-and-spoke consolidation enables centralization of routine microbiology while preserving time-critical diagnostics. Contingent upon reliable transport, it protected urgent workflows, harmonized standard operating procedures, validated LIS routing, active stakeholder communication, and sustained governance from the outset.