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Stepwise Success

Turnaround Time

Published June 24, 2009 7:05 AM by Scott Warner

Suppose you want to measure turnaround time for ED specimens. This naturally raises the question What is turnaround time?

According to one article in Clinical Biochemist, although clinicians complain about turnaround times being too long, most don't agree on what is acceptable. Or even what it is: according to a 1998 CAP Q-Probes program, over 40% of physicians say the clock starts when a test is ordered. They perceive delay, not process. By contrast, 41% of labs say turnaround time starts at receipt, 27% at order, and 18% at collection.

The problem is simple for a bench tech. Measurements of performance as an average, 90th percentile, or median time all can be heard as "work faster." And if techs work faster for the sake of speed, they can make careless mistakes. It really doesn't matter how it's defined. Once techs get the message they aren't working fast enough, the damage is done.

But measuring turnaround time as an indicator of variation can show where to improve the process. This variation may be preanalytical (ED ordering time and collection), analytical (handling and instrument), or postanalytical (verification and completion). Measuring steps of the total deemphasizes a single speed limit and may be better accepted by techs.

If the time from drop off to centrifugation is longer or more variable at busier times of the day, this may be reduced by adding a STAT centrifuge. If the time from chemistry bench to LIS varies, autoverification of routine results may allow techs to concentrate on abnormal values. Maybe, the problem is outside the laboratory altogether. Working faster may not be the answer. Imagine that.

It's like buying a Ferrari to travel from your house to the post office when the real problems are traffic lights, afternoon school buses, or too many pedestrians. You don't need to drive faster. You need a different route.

2 comments

Ryan,

Good points.  Any system to measure TAT should try to isolate variables.  What amazes me is how perceptions persist despite hard data.  "The lab is slow" is said often enough until it becomes truth, when the variation is often outside the laboratory as you suggest.

Scott Warner July 7, 2009 5:58 AM

In discussion of TAT, irregardless of how whoever measures it by whatever parameters..  have other factors been taken into account as to what can affect it?

Big one - Staffing and times of day measured.  Obviously peak analytical times (morning run, off site drop offs, lunch/dinnertime and such..) can be taken into account as far as to number of specimens per instrument or number of verifiable results [problems] per analytical technologist.

Second - a wild card .. unnecessary tests.  Yeah..  Just how many of those tests that come from the floors or ED that we draw, receive and analyze each day are clinically necessary?  Does every ED patient really need the full rainbow of tubes for tests and UA and the like?  or can they get away with less?  How many of the tests from the floors are duplicates or overlaps or have orders with no stop times?    Obviously if they are not needed or are unnecessary, they waste tech time and get in the way of other samples of a higher priority

As you said before in one of your previous blogs, Scott, computers were supposed to make data processing easier; when, in fact, they only seem to generate more work in the long run.  Hopefully as newer systems come out they can become more sophisticated in detecting errors like the above and eliminate or block them before they make it to the label.

Thirdly,..  -  Specimen errors that completely kill TAT and are a hinderance to us, the Docs and the patients.  Those samples  that come up contaminated, mislabeled, unlabeled, improperly collected or just not at all.   Time is wasted preanalytically collecting and processing before any error is detected and once it is detected the corrective action process is activated.  All taking time away from our normal procedures.

Ryan July 3, 2009 6:06 PM
NY

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