Utilization of Stat Test Priority in the Clinical Laboratory: A College of American Pathologists Q-Probes Study of 52 Institutions

Abstract

Context.-Utilization of stat testing priority is a balance between safe, efficient patient management and resource expenditure.Objective.-To determine the rate of stat testing, compare rates among institutions, and determine the distribution of turnaround time expectations for different turnaround time priorities.Design.-During a 7-day period, participants prospectively determined the total number of chemistry, hematology, and coagulation billable tests from inpatients and emergency department patients. Among these, the total numbers of billable tests performed stat were identified. Laboratories also reported the levels of test priority they offered and turnaround expectations for each level of test priority.Results.-Fifty institutions submitted data for the study, with 2 additional participants submitting partial results.Participants identified 639 589 chemistry, hematology, and coagulation billable tests, with 229 896 (35.9%) performed stat. The stat rate varied from 21.3% at the 10th percentile to 55.4% at the 90th percentile, with a median of 37.0% of participants' tests performed stat. Laboratories include a mean of 206 tests in chemistry, hematology, and coagulation test menus, with 67% of these tests offered stat. The fraction of the test menu offered stat varied from 29.0% at the 10th percentile to 97.8% at the 90th percentile, with a median of 73.3% of tests on the menu offered stat. The most common number of testing priorities offered by participating laboratories was 3 (44.2%).Conclusions.-Among the 52 participating laboratories, the median stat testing rate was 37.0% and a median 73.3% of the test menu was offered stat.

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

“…The management team of the study examined patient LOS and found 60-70% of the 150 patient visits per day underwent laboratory testing. Although our Lab TAT goal for stat testing is 60 minutes, consistent with other labs in North America [8, 11-12], the audited 90 th percentile TAT (Lab TAT90; the time for 90% of laboratory tests to be complete) was consistently greater than 80 minutes. Laboratory TAT for ED patients was targeted for process improvement.…”

“…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.…”

The Feasibility and Impact of Midnight Routine Blood Draws on Laboratory Orders and Processing Time

“…Reduction of excessive stat order requests supports safe and efficient patient care 20,21 and may reduce laboratory costs. 22 Further, the study has potential implications for improving patient-centeredness of blood draw practices for hospitalized patients. Although we acknowledge that midnight may not be the best time for patients, the trial of midnight blood draws questioned the rationality of early morning blood draws.…”

Twenty-Five Years of Accomplishments of the College of American Pathologists Q-Probes Program for Clinical Pathology

“…The number of institutions participating in the studies listed in Table 4 ranged from 151 to 630; however, other studies have had participants from more than 900 institutions 8 or from as few as 52 institutions. 9 In these examples, the size of the databases ranged from 623 different practice patterns for notification of a test critical value to more than 18 million units of crossmatched blood in the blood utilization study.…”