Evaluation and Improvement Strategy of Analytical Turnaround Time in the Stat Laboratory

Chien, Tzu-I; Lü, Jinying; Kao, Jau-Tsuen; Cheng, Ya-Chih; Lee, Ya-Fen

doi:10.1016/s0929-6646(07)60006-0

Cited by 13 publications

(11 citation statements)

References 14 publications

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“…Chien, et al reported that a dedicated process control was able to significantly improve laboratory efficiency [23]. Our lab scientist proceeded to identify factors for improvement after reviewing the study results.…”

Section: Discussionmentioning

confidence: 99%

“…The primary outcome was 90 th percentile test completion from specimen receipt in the lab to the result being reported (In-Lab-TAT90), a better indicator of laboratory performance than mean or median TAT [8, 11]: it captures much of the modifiable outlier effect and represents a standard of consistency required for ED care [23]. Survival analysis was used to determine the In-Lab-TAT90 and 95% confidence interval (CI) for each analyte.…”

Section: Methodsmentioning

confidence: 99%

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Does Elimination of a Laboratory Sample Clotting Stage Requirement Reduce Overall Turnaround Times for Emergency Department Stat Biochemical Testing?

Compeau¹,

Howlett²,

Matchett³

et al. 2016

Cureus

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Introduction: Laboratory turnaround times (TAT) influence length of stay for emergency department (ED) patients. We studied biochemistry TATs around the implementation of a plasma separating tube (PST) that omitted a 20-minute clotting step in processing when compared to the standard serum separating tubes (SST).Methods: We compared laboratory TATs using PST vs SST in a prospective before-and-after study with a washout period. TATs for creatinine, urea, electrolytes, troponin, and N-terminal pro b-type natriuretic peptide (NT-proBNP), as well as hemolysis rates, were collected for all ED patients. Results were excluded if the TAT was four minutes or less (data entry error). We recorded the 90th percentile response times (TAT90; the time for 90% of the tests to be completed). Statistical analysis used survival analyses, Mann-Whitney U tests, and Chi-square tests of independence.Results: SST and PST groups were matched for days of the week, critical values, or hemolysis. There was a statistically significant reduction in median TAT and proportion completed by 60 minutes. However, the effect size was only two to four minutes in the In-Lab-TAT90 with the PST tubes for all tests, except B-type natriuretic peptide (BNP).Conclusions: Reducing the machine processing time for stat blood work with PST tubes did not produce a clinically meaningful reduction of TAT. Clinically important improvement for Lab TAT requires process analysis and intervention that is inclusive of the entire system. Fractile response times at a 90th percentile for TAT within 60 minutes may be an accurate benchmark for analysis.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Does Elimination of a Laboratory Sample Clotting Stage Requirement Reduce Overall Turnaround Times for Emergency Department Stat Biochemical Testing?

Compeau¹,

Howlett²,

Matchett³

et al. 2016

Cureus

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show abstract

“…9 According to Tzu-I Chien et al, prioritising the test performance and dedicated means of process control can significantly reduce the TAT of emergency tests without affecting the overall TAT. 10 In a single centre intervention brought about by White BA et al, application of lean methodologies in the form of reallocation of resources without the addition of new resources and simple reorganisation of laboratory process flow effectively decreased the laboratory TAT. 11 Along with customer satisfaction, decreased laboratory TAT also improves the efficiency of ED work by allowing the early diagnosis, treatment, patient discharge and provides a way of cost cutting.…”

Section: Before Intervention After Interventionmentioning

confidence: 99%

Effectiveness of Implementing Process Improvement Strategies on Turnaround Time of Emergency Investigations, in Clinical Biochemistry Laboratory

Patil¹,

Patil²,

Kulkarni³

et al. 2019

Indian Journal of Medical Biochemistry

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Background: Turnaround time (TAT) is one of the most noticeable signs of a laboratory service and is used by many clinicians as a benchmark to judge the quality of laboratory service. Despite automation and computerisation, delayed TAT of emergency department (ED) samples was a complaint received in our clinical biochemistry laboratory. After process mapping and root cause analysis, we designed an improvement strategy which included the introduction of emergency request forms (ERF), creating awareness in the technical staff by proper training and streamlining the work flow path. Aim: To compare the TAT of ED samples for electrolytes, received 1month before and after implementing the process improvement strategy. Materials and methods: Data regarding the number of electrolyte assays ordered from ED for 1 month before and after implementing the improvement strategy was obtained from hospital laboratory information system (LIS). TAT was calculated as the interval between sample accession in the laboratory and the time results were reported in LIS. Independent sample 't' test was used to compare the mean TAT before and after the intervention Results: Independent sample 't' test showed reduction in the TAT of ED electrolyte assays after intervention compared to before intervention (78.74 and 110.08 min respectively) with a statistically significant (p<0.001) difference of 31.34 min. Conclusion: Significant reduction in the TAT of ED samples after intervention highlighted the power of analytical phase intervention in the form of reallocation of resources and staff awareness in effectively reducing the TAT. The study also proved the usefulness of having separate colour coded ERF in early identification, segregation and processing of ED samples. Clinical Significance: Decreased laboratory turnaround time of ED investigations is clinically significant because along with customer satisfaction it also improves the efficiency of work by allowing the early diagnosis, treatment, patient discharge and provides a way of cost cutting. and population served. According to CAP Q probe assay, there are differences between clinicians and laboratories in their definition of TAT. 1 The term therapeutic TAT is used to describe the interval between the test order and the time when treatment decision is made. Perhaps many steps in the total testing cycle occur outside the laboratory and are not under direct control of the laboratory

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“…The CBC analysis performed by large hematology instruments in centralized laboratories today is therefore routinely used to evaluate and monitor bone marrow function in general and specifically in hematological disorders and diseases 4 . However, despite extensive automation, there are inherent challenges in centralizing clinical laboratories (eg, sample logistics and sample processing time) which makes it difficult to achieve turn‐around times (TATs), from requisition/arrival of the patient to availability of results, in less than 30 minutes to 2 hours 5‐7 . A way of overcoming these challenges and achieving TAT <10 minutes is to decentralize the CBC analyses using point‐of‐care (POC) hematology devices to evaluate white blood cells (WBC), platelet (PLT) counts and hemoglobin (HGB) 8 .…”

Section: Introductionmentioning

confidence: 99%

The HemoScreen hematology point‐of‐care device is suitable for rapid evaluation of acute leukemia patients

Kur

Thøgersen

Kjeldsen

et al. 2020

Int J Lab Hematology

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Background Hematological patients, receiving intensive chemotherapy (predominantly acute leukemia patients), have repeated postchemotherapy periods with severe bone marrow suppression. As a result, these patients require regular monitoring of the complete blood counts (CBC) for optimal patient care. To reduce the strain on the patient, there is a need for a point‐of‐care (POC) hematology device that provides rapid and reliable results both in general and in cytopenic samples and is suitable for outpatient clinics. We evaluated the HemoScreen device for the most used CBC parameter both overall and at the lower range. Methods The HemoScreen was compared with the Sysmex XN‐9000 in 206 routine venous samples and 79 capillary bedside samples focusing on white blood cells (WBC), absolute neutrophil count (ANC), red blood cells (RBC), PLT and HGB. Results The HemoScreen was less precise compared to the acceptance criteria set for larger and more advanced hematology instrument with a CV% 3.0‐3.7 for WBCs, 3.6‐8.4 for ANCs, 1.1‐1.5 for RBCs, 2.5‐4.4 for PLTs, and 1.7‐2.3 for HGB. Correlation coefficient for all five parameters for the entire range was r >.95 and r >.90 at lower range for venous and capillary samples. Bias limits were within the CTCAE acceptance limits. Conclusions The HemoScreen provides rapid and accurate test results, for evaluation of WBC, PLT, and HGB, as well as at low concentrations for guiding transfusions and postchemotherapy treatment. The device is easy to operate and can measure both venous and capillary samples. Therefore, the HemoScreen is well suited for smaller outpatient clinics and potentially home use.

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Evaluation and Improvement Strategy of Analytical Turnaround Time in the Stat Laboratory

Abstract: These findings demonstrated that a dedicated means of process control was able to significantly improve laboratory efficiency.

Cited by 13 publications

References 14 publications

Does Elimination of a Laboratory Sample Clotting Stage Requirement Reduce Overall Turnaround Times for Emergency Department Stat Biochemical Testing?

Does Elimination of a Laboratory Sample Clotting Stage Requirement Reduce Overall Turnaround Times for Emergency Department Stat Biochemical Testing?

Effectiveness of Implementing Process Improvement Strategies on Turnaround Time of Emergency Investigations, in Clinical Biochemistry Laboratory

The HemoScreen hematology point‐of‐care device is suitable for rapid evaluation of acute leukemia patients

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