CLN Article

Adventures in Turnaround Time

Bench Matters: June 2016

Joseph Drwiega, MD, Carolyn Chaffin, MT(ASCP), Robert Hardy, PhD

In today’s ever-changing healthcare environment, labs are under the gun to deliver better service to both clinicians and patients. With this in mind, turnaround time (TAT) is a conspicuous component of laboratory services because clinicians, inspectors, and patients can easily quantify this key variable. Improved TAT in hospital labs has positive implications in at least five key areas:

  • Optimized patient outcomes. In emergency settings, for instance, troponin results clarify diagnosis and management of patients with chest pain.
  • Reduced costs. Timely test results can forestall hospital admissions or cut length of hospitalization.
  • Better clinician satisfaction. When physicians receive test results promptly, they have fewer complaints about lab service.
  • Higher patient satisfaction. Timely receipt of lab test results is one way patients evaluate hospital and physician care.
  • Better competitive position against other labs.
  • Potential for improved reimbursements through profit sharing.

In the case of outpatient labs, more timely results enable clinicians to act on lab results before patients leave the facility, thereby saving patients from return visits and lessening any problems physicians might have with post-visit follow-up.

The Slow Way to Speed

Our institution, UAB Hospital in Birmingham, Alabama, is a large academic medical center, and in 2005 several factors conspired to compromise our TAT. Our chemistry lab was without an automated line, we lacked real-time TAT monitors, and we did not have an optimal layout in that our accessioning area was distant from our instruments. At this time we also were reviewing all our test results manually, and we had dated equipment. Our testing volume was going up, but we lacked autoverification to deal with this increase. In addition, we experienced fairly frequent hospital information system downtimes and had staffing issues.

On the plus side, then and now, a pneumatic tube system brings samples to the lab, and our accessioning team is efficient. We also have satellite labs that help us meet not only the high demands of critical care locations throughout the hospital, but also those of our emergency department and outpatient clinics. These satellites each have customized testing menus that eliminate time wasted in transporting samples. They also enable us to rapidly provide important test results such as arterial blood gases and troponin. Point-of-care testing (POCT) also features prominently not only in our satellite labs, but also throughout the hospital and clinics.

Our use of satellite labs and POCT has been very helpful in reducing hotspot TATs; however, the core chemistry lab has been our focus for approximately the last 10 years. Looking back on our TAT data from 2005—defined as receipt of sample in the lab to the result being verified—we were getting 85–90% of our STAT basic metabolic panel TATs reported in 1 hour, failing to meet our goal of 95% from 2005–2007.

Finding Solutions

To tackle these issues, from November 2007 to September 2009, we implemented new chemistry instruments, autoverification, a more efficient physical layout of the lab and instruments, and installed a TAT TV monitor to alert our techs of samples that were about to exceed the acceptable TAT threshold. In November 2007 we also switched to new instruments that use a closed-tube sampling system. These efforts enabled us to meet our TAT goal of >95% through July 2012.

Despite these positive results, there always seem to be TAT-related challenges that, too often, are out of our control. For example, in June 2008 our new hospital information system caused a drop in our acceptable TAT. More recently, our once-new instruments began to show signs of aging with more frequent downtime. Our testing volume has only risen, and construction as part of the installation of an automated chemistry line also hindered an acceptable TAT due both to less efficient movement of samples throughout the lab and equipment downtime. In April 2015, we purchased and implemented new instruments, and as expected, this noticeably improved TAT shortly thereafter. We expect to complete and start running our automation line within the next couple of months, and we anticipate that we, like others who have implemented automation, will see TATs—especially the tightly clustered ones—stabilize.

Maintaining optimal TATs is an ongoing challenge. Nevertheless, in our experience, optimizing parameters that labs can control makes a significant dent in this important service parameter.

Joseph Drwiega, MD, is a pathology resident at the University of Alabama at Birmingham.+Email: [email protected]

Carolyn Chaffin, MT(ASCP), is supervisor of the chemistry lab at the University of Alabama at Birmingham.+Email: [email protected]

Robert Hardy, PhD, is a professor and section head of clinical chemistry at the University of Alabama at Birmingham.+Email: [email protected]