The turnaround time of laboratory results of inpatients at a local general hospital.

Abstract

For laboratory tests to be useful, they must be available in a timely manner. The way in which doctors use laboratory data generally dictates that the faster the test turnaround time (TAT), the better. However, in St. Luke's Hospital (SLH), TAT has not been benchmarked and included amongst one of the measures of laboratory quality. Using purposely designed TAT survey forms, the researcher measured stat and routine 'collection to report' TAT for CBCs, electrolytes and APTTs over a 14-day period in two surgical wards in SLH. The time for each step of specimen and result processing was recorded. Thus, the median TATs for each test, as categorised by different laboratory and ward type were derived. The perceptions and expectations of doctors and laboratorians working in SLH were also gathered using purposely designed and validated questionnaires. Results indicate that measured median TATs were much higher than doctors' and laboratorians' expectations but were lower than the TATs perceived to prevail in SLH. Both cohorts of respondents felt that the TATs should be reduced. Routine CBC, electrolytes and APTT had median TATs of 308, 1745 and 335 minutes respectively whilst stat CBC, electrolytes and APTT had median TATs of 205, 225 and 230 minutes respectively. TATs varied significantly, depending on ward type and specimen courier type. Post-analytic TAT was revealed to be longer than pre-analytic TAT while the analytic TAT was the shortest. Both doctors and laboratorians perceived TAT to be relevant to health costs, doctors' satisfaction levels, patient care and length of stay in SLH. Timeliness was considered as the most important quality attribute after accuracy and precision. Results suggest that a laboratory information system (LIS) could reduce post-analytic TAT by up to 85% while a pneumatic tube system (PTS) could reduce pre-analytic TAT by up to 26%. With both LIS and PTS implemented together, current TAT could be almost halved. Among several management implications and recommendations, the researcher suggests that although the implementation of the LIS and PTS should significantly lower TAT, further reduction in TAT would be required to reach international and doctor acceptable standards. A main concern was the exceptionally high TAT for' routine electrolytes that should be analysed and lowered accordingly. In the longer term, the laboratory could bring together doctors and laboratorians in an interdisciplinary team approach to jointly develop TAT goals and benchmarks and improve TAT performance. Following accreditation, the laboratory could increase awareness, among doctors, of the newly reached standards and embark on an educational campaign on the benefits and practice of having shorter TATs. Representatives could be appointed from each profession to address outlier TATs on a day to day basis. TAT awareness could also be included in the training curriculum of healthcare and medical students. The implementation of a wireless system to alert doctors on abnormal results and regular tracking of laboratory workflow to ensure adequate resource utilisation are among other suggestions. The preparation of a timeliness report as part of the annual laboratory report is also recommended. Eventually, when TAT becomes acceptable for local doctors, the laboratory should start" participating in an international quality assurance program that focuses on TAT. If the interdisciplinary team manages to control workload concurrently with the TAT improvement initiatives, a 24-hr laboratory that treats all specimens efficiently and uniformly, could eventually also be considered. (Key words: Turnaround time; Timeliness of results; Laboratory information system; Pneumatic tube system; Laboratory automation).