Objectives: The objective was to examine the relationship between laboratory testing (including test volume and turnaround time [TAT]) and emergency department (ED) length of stay (LOS), using linked patient-level data from four hospitals across 4 years.Methods: This was a retrospective, multisite cohort study of patients presenting to any one of four EDs in New South Wales, Australia, during a 2-month period (August and September) in 2008, 2009, 2010, and 2011. Data from ED information systems were linked to laboratory test data. A cross-classified random-effect modeling approach was applied to identify factors affecting ED LOS, taking into account the correlation between patients' presentations at the same hospital and/or in the same calendar year. Number of test order episodes (tests ordered at one point in time during the ED stay) and TAT (time from laboratory order receipt to result available) were examined.Results: As the number of test order episodes increased, so did the duration of patient ED LOS (p < 0.0001). For every five additional tests ordered per test order episode, the median ED LOS increased by 10 minutes (2.9%, p < 0.0001); each 30-minute increase in TAT was, on average, associated with a 5.1% (17 minutes; p < 0.0001) increase in ED LOS, after adjustment for other factors. Patients presenting to the ED at night (7 p.m. to 7 a.m.) had longer stays than those presenting during the daytime, although the median TATs at nights were shorter than those during the daytime.Conclusions: Laboratory testing has a direct effect on patients' LOS in ED. Laboratory TAT, number of testing episodes, and test volume influence ED LOS. Targeted increases of ED resources and staffing after-hours may also contribute to reductions in ED LOS.ACADEMIC EMERGENCY MEDICINE 2015;22:38-46

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Manual data-entry of handwritten serology requests is an error-prone process. Electronic ordering has the potential to eliminate illegible handwriting and transcription errors, thus improving data accuracy in hospital information systems.

The volume of add-on requests is substantial and varies considerably by test type and patient registration category thus impacting differentially upon pathology service departments. While some add-on requests are unavoidable in clinical practice, others are precipitated by inadequate information at the point of care. Improving appropriate utilization of add-on testing will reduce their burden on pathology services.

F ifteen cases of meningococcal disease occurred in South Western Sydney Area Health Service (SWSAHS) in 1991. Figure 7 shows the distribution of cases by month, and Table 8 summarises the cases. Seven of these cases (six patients with meningitis and one with septicaemia) occurred between July 17 and August 3. Five of seven patients (cases 5,6,8, 10 and 11 of Table 8) were from the Campbelltown Local Government Area (LGA). All the cases from the Carnphelltown LGA were caused by Group C meningococcus. The incidence of meningococcal disease in NSW is about 1-2 cases/100,000 people per yeart. On the basis of this rate, we would expect two or three cases a year of meningococcal disease in the Campbelltown LGA, and 7-13 cases a year in the Area as a whole. While meningococcal disease occurs more commonly in winter and spring this clustering of cases in late July-early August was a cause of concern, particularly in light of reported outbreaks associated with Group C meningococcus in Western Australia and Queensland4. MENINGOCOCCAL DISEASE IN SW5AH5.