Timeliness of automated routine laboratory tests: a College of American Pathologists Q-Probes study of 653 institutions

Turnaround Time: An Efficacy Measure for Medical Laboratories

Turnaround time (TAT), which doctors frequently use as the benchmark for laboratory performance, is a typical way to communicate timeliness. It also acts as a quality indicator to evaluate the effectiveness and efficiency of the testing process and the satisfaction of clinicians and patients. TAT is the time from receipt of the sample in the laboratory to final delivery or dispatch of the report of said test. The TAT procedure can be broadly divided into three stages pre-analytical, analytical and post-analytical. There is variability in TAT according to different conditions like the volume of sample size, staff expertise, availability of adequate resources, distances of the hospital from the lab, and various sub-departments. To remove obstacles to optimizing TAT, we must take a practical approach. A workload reduction plan, proper stock management, specialized work assignments, and skilled staff retention are crucial strategies to reduce the setting's delayed TAT.

Reforms, Errors, and Dermatopathology Malpractice: Then and Now: A Comprehensive Retrospective

Medical malpractice occurs when a hospital, doctor, or other health care professional, through a negligent act or omission, causes an injury to a patient. The negligence might be the result of errors in diagnosis, treatment, aftercare, or health management. To be considered medical malpractice under the law, the claim must violate the standard of care, the injury must be caused by the negligence and, last but most certainly not least, the injury must result in significant damages. This review is an overview of medicolegal issues specific to the practice of Dermatopathology with the caveat that most are likely pertinent to other specialties of pathology as well. The safety of patients remains the priority in pathology as it does in any medical undertaking, and this is no different in the practice of Dermatopathology. The review is broadly divided in 2 parts-we begin with an overview of tort reforms, advocated by physicians to reduce costs associated with malpractice defense. In the second part we address practical issues specific to the practice of pathology and dermatopathology. These include among others, errors-related to the biopsy type, inadequacy of clinical information regarding the lesion that is biopsied, role of interstate dermatopathology as well as examples of select entities commonly misdiagnosed in dermatopathology. In the last decade, artificial intelligence (AI) has moved to the forefront of technology. While research into the uses of AI in pathology is promising, the use of AI in diagnostic practice is still somewhat uncommon. Given that AI is not fully integrated routinely as a diagnostic adjunct, its' impact on pathology-specific medicolegal issues cannot, as yet at least, be defined. Restriction of medical malpractice is of particular relevance in the COVID-19 era, a period that is anything but normal. The response of states with specific pandemic-related guidelines is addressed with the caveat that this particular issue is only covered in select states. Furthermore, given that the COVID pandemic is only a year old, while it does not appear to have had an immediate impact on pathology-specific medicolegal matters, it is possible that the role of COVID on this issue, if any at all, will and can only be fully defined a few years down the line.

A critical review of laboratory performance indicators

Healthcare budgets worldwide are under constant pressure to reduce costs while improving efficiency and quality. This phenomenon is also visible in clinical laboratories. Efficiency gains can be achieved by reducing the error rate and by improving the laboratory's layout and logistics. Performance indicators (PIs) play a crucial role in this process as they allow for performance assessment. This review aids in the process for selecting laboratory PIs-which is not trivial-by providing an overview of frequently used PIs in the literature that can also be used in clinical laboratories. We conducted a systematic review of the laboratory medicine literature on PIs. As the testing process in clinical laboratories can be viewed as a production process, we also reviewed the production processes literature on PIs. The reviewed literature relates to the design, optimization or performance assessment of such processes. The most frequently cited PIs relate to pre-analytical errors, timeliness, resource utilization, cost, and the amount of congestion. Their citation frequency in the literature is used as a proxy for their importance. PIs are discussed in terms of their definition, measurability and impact. The use of suitable PIs is crucial in production processes, including clinical laboratories. By also reviewing the production processes literature, additional relevant PIs for clinical laboratories were found. The PIs in the laboratory medicine literature mostly relate to laboratory errors, while the PIs in the production processes literature relate to the amount of congestion in the process.

Magnitude of delayed turnaround time of laboratory results in Amhara Public Health Institute, Bahir Dar, Ethiopia

BACKGROUND

Clinical decisions depend on timely laboratory result reporting. The timeliness is commonly expressed in turnaround time and serves as a quality improvement tool to assess the effectiveness and efficiency of the laboratory. According to the International Organization for Standardization (ISO) guidelines, each laboratory shall establish turnaround times for each of its examinations that reflect clinical needs, and shall periodically evaluate whether or not it is meeting the established turnaround times. Therefore, this study aimed to assess the TAT of laboratory results done in the reference laboratories of the Amhara Public Health Institute, Bahir Dar, Ethiopia.

METHODS

A retrospective cross sectional study was carried out from 01 January to 31 September 2018. Each patient sample was considered as a study unit. Nine months data were extracted from the sample tracking log and from the Laboratory Information System (LIS) database. Descriptive and summary statistics were calculated using SPSS version 20.0 statistical software.

RESULTS

A total of 34,233 patients samples were tested during the study period. Monthly average TAT ranged from 38.6 to 51.3 days for tuberculosis (TB) culture, 5.3 to 42.4 days for exposed infant diagnosis (EID) for HIV, 8.4 to 26 days for HIV 1 viral load, and 1.9 to 3.5 days for TB genexpert tests. Compared with the standard, 76.5% of the viral load, 68.1% of the EID for HIV and 53.8% of the TB genexpert tests had delayed TAT. Repeated reagent stock out, high workload, activities overlapping, and staff turnover were major reasons for the result delays.

CONCLUSIONS

There was a delayed turnaround time of laboratory results in APHI. HIV viral load, EID and TB genexpert results were the most affected tests. Workload reduction plan, proper stock management, specific work assignment and trained staff retention are important approaches to minimize the delayed TAT in the setting.

An Audit of VDRL Testing from an STI Clinic in India: Analysing the Present Scenario with Focus on Estimating and Optimizing the Turnaround Time

BACKGROUND

Timeliness of reporting is of utmost importance to limit the spread of syphilis. The present analysis was undertaken to evaluate the turnaround time of syphilis testing (mainly Venereal disease research laboratory /VDRL test) in a sexually transmitted infections (STI) clinic in India; to find out the possible reasons for delay; to describe the trends of clinical indications for syphilis testing from an STI clinic; to assess the frequency of a positive syphilis serology among STI clinic attendees; and to analyse the follow-up rates of VDRL report collection.

MATERIALS AND METHODS

Two hundred consecutive VDRL requests received at the serology laboratory of a tertiary care health facility from the STI clinic of the linked hospital were prospectively analysed to evaluate the above parameters.

RESULTS

For the 200 requests audited, the mean absolute turnaround time of VDRL test was 7.46±2.81 days. The mean duration of the pre-laboratory, laboratory and post laboratory phases was 0, 4.69±2.13 and 2.77±2.51 days respectively. The interval from specimen receipt to performance of tests (mean duration=4.25±1.96 days) was the major reason for long VDRL turnaround time. The common indications for syphilis testing in STI clinic attendees were lower abdominal pain (33%), vaginal discharge (26.5%) and genital ulcer disease (9%); and the follow-up rate for report collection was 71%.

CONCLUSION

Our study highlights the strong need to shift to alternative testing methods, mainly rapid point of care procedures for serodiagnosis of syphilis in order to circumvent the problems of long turnaround time and low patient follow-up rates.

Twenty-five years of accomplishments of the College of American Pathologists Q-probes program for clinical pathology

CONTEXT

During the past 25 years, the College of American Pathologists' (CAP) Q-Probes program has been available as a subscription program to teach laboratorians how to improve the quality of clinical laboratory services.

OBJECTIVE

To determine the accomplishments of the CAP Q-Probes program.

DESIGN

We reviewed Q-Probes participant information, study data and conclusions, author information, and program accomplishments.

RESULTS

During this time 117 Q-Probes clinical pathology studies were conducted by 54 authors and coauthors, 42,899 laboratories enrolled from 24 countries, 98 peer-reviewed publications occurred and were cited more than 1600 times, and the studies were featured 59 times in CAP Today. The most frequent studies (19) focused on turnaround times for results or products at specific locations (emergency department, operating room, inpatients, outpatients), specific diseases (acute myocardial infarction, urinary tract), availability for specific events such as morning rounds or surgery, a specific result (positive blood cultures), and a method on how to use data for improvement (stat test outliers). Percentile ranking of study participants with better performance provided benchmarks for each study with attributes statistically defined that influenced improved performance. Other programs, such as an ongoing quality improvement program (Q-Tracks), a laboratory competency assessment program, a pathologist certification program, and an ongoing physician practice evaluation program (Evalumetrics), have been developed from Q-Probes studies.

CONCLUSIONS

The CAP's Q-Probes program has made significant contributions to the medical literature and has developed a worldwide reputation for improving the quality of clinical pathology services worldwide.

Monitoring and root cause analysis of clinical biochemistry turn around time at an academic hospital

Quality can be defined as the ability of a product or service to satisfy the needs and expectations of the customer. Laboratories are more focusing on technical and analytical quality for reliability and accuracy of test results. Patients and clinicians however are interested in rapid, reliable and efficient service from laboratory. Turn around time (TAT), the timeliness with which laboratory personnel deliver test results, is one of the most noticeable signs of laboratory service and is often used as a key performance indicator of laboratory performance. This study is aims to provide clue for laboratory TAT monitoring and root cause analysis. In a 2 year period a total of 75,499 specimens of outdoor patient department were monitor, of this a total of 4,142 specimens exceeded TAT. With consistent efforts to monitor, root cause analysis and corrective measures, we are able to decreased the specimens exceeding TAT from 7-8 to 3.7 %. Though it is difficult task to monitor TAT with the help of laboratory information system, real time documentation and authentic data retrievable, along with identification of causes for delays and its remedial measures, improve laboratory TAT and thus patient satisfaction.

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

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.

Turnaround Time and Timeliness of Physician Interpretation in the Vascular Laboratory

The overall turnaround time (TAT) and the physician interpretation interval (PII) for vascular laboratory (VL) tests are not often reported in the literature. Objective: To audit the TAT and PI on weekdays (WDs) and weekends/holidays (WE). Methods: The first available wait time (WT), the type of test, and the PII for weekday versus weekends/holidays for all patients was noted. Results: The mean WT for inpatients between order and performance of the VL test was 12.48 and 9.81 hours for WD, respectively. The mean PII was 3.23 hours. There was a significant difference in PII between WD (mean 2.30 hours) and WE (16.60 hours; P < .0001). Ninety-nine percent of tests on WD were read within 24 hours compared to 76.5% on WE ( P < .0001). Conclusions: Process improvement of the TAT should lead to better customer satisfaction, improve access to test results, and be a part of quality assurance in the VL.

[Regional pilot study to evaluate the laboratory turnaround time according to the client source]

PURPOSE

To show turnaround time to client source in eight laboratories covering eight Health Areas (2,014,475 inhabitants) of the Valencian Community (Spain).

MATERIAL AND METHODS

Internal Laboratory Information System (LIS) registers (test register and verification date and time), and daily LIS registers were used to design the indicators, These indicators showed the percentage of key tests requested (full blood count and serum glucose and thyrotropin) that were validated on the same day the blood was taken (inpatients and Primary Care and/or at 12 a.m. (inpatients). Urgent (stat) tests were also registered as key tests (serum troponin and potassium) and were recorded in minutes. Registers were collected and indicators calculated automatically through a Data Warehouse application and OLAP cube software.

RESULTS

Long turnaround time differences were observed at 12 a.m. in inpatients, and in the day of sample extraction in primary care patients. The variability in turnaround of stat tests is related to hospital size, activity and validation by the laboratory physician.

CONCLUSIONS

The study results show the large turnaround time disparity in eight Health Care Areas of Valencian Community. The various requesting sources covered by the laboratories create the need for continuous mapping processes redesign and benchmarking studies to achieve customer satisfaction.

Quality and timeliness in medical laboratory testing

In terms of testing, modern laboratory medicine can be divided into centralized testing in central laboratories and point-of-care testing (POCT). Centralized laboratory medicine offers high-quality results, as guaranteed by the use of quality management programs and the excellence of the staff. POCT is performed by clinical staff, and so such testing has moved back closer to the patient. POCT has the advantage of shortening the turnaround time, which potentially benefits the patient. However, the clinical laboratory testing expertise of clinical staff is limited. Consequently, when deciding which components of laboratory testing must be conducted in central laboratories and which components as POCT (in relation to quality and timeliness), it will be medical necessity, medical utility, technological capabilities and costs that will have to be ascertained. Provided adequate quality can be guaranteed, POCT is preferable, considering its timeliness, when testing vital parameters. It is also preferred when the central laboratory cannot guarantee the delivery of results of short turn-around-time (STAT) markers within 60 or (even better) 30 min. POCT should not replace centralized medical laboratory testing in general, but it should be used in cases where positive effects on patient care have been clearly demonstrated.

Errors in laboratory medicine: practical lessons to improve patient safety

CONTEXT

Patient safety is influenced by the frequency and seriousness of errors that occur in the health care system. Error rates in laboratory practices are collected routinely for a variety of performance measures in all clinical pathology laboratories in the United States, but a list of critical performance measures has not yet been recommended. The most extensive databases describing error rates in pathology were developed and are maintained by the College of American Pathologists (CAP). These databases include the CAP's Q-Probes and Q-Tracks programs, which provide information on error rates from more than 130 interlaboratory studies.

OBJECTIVES

To define critical performance measures in laboratory medicine, describe error rates of these measures, and provide suggestions to decrease these errors, thereby ultimately improving patient safety.

SETTING

A review of experiences from Q-Probes and Q-Tracks studies supplemented with other studies cited in the literature.

DESIGN

Q-Probes studies are carried out as time-limited studies lasting 1 to 4 months and have been conducted since 1989. In contrast, Q-Tracks investigations are ongoing studies performed on a yearly basis and have been conducted only since 1998. Participants from institutions throughout the world simultaneously conducted these studies according to specified scientific designs. The CAP has collected and summarized data for participants about these performance measures, including the significance of errors, the magnitude of error rates, tactics for error reduction, and willingness to implement each of these performance measures.

MAIN OUTCOME MEASURES

A list of recommended performance measures, the frequency of errors when these performance measures were studied, and suggestions to improve patient safety by reducing these errors.

RESULTS

Error rates for preanalytic and postanalytic performance measures were higher than for analytic measures. Eight performance measures were identified, including customer satisfaction, test turnaround times, patient identification, specimen acceptability, proficiency testing, critical value reporting, blood product wastage, and blood culture contamination. Error rate benchmarks for these performance measures were cited and recommendations for improving patient safety presented.

CONCLUSIONS

Not only has each of the 8 performance measures proven practical, useful, and important for patient care, taken together, they also fulfill regulatory requirements. All laboratories should consider implementing these performance measures and standardizing their own scientific designs, data analysis, and error reduction strategies according to findings from these published studies.

Continuous monitoring of stat and routine outlier turnaround times: two College of American Pathologists Q-Tracks monitors in 291 hospitals

CONTEXT

The laboratory test turnaround times (TATs) that exceed the expectations of clinicians who order those tests, the so-called outlier test reporting rates, may be responsible for perceptions of inadequate laboratory service.

OBJECTIVE

To monitor outlier test reporting rates for emergency department stat potassium results and routine inpatient morning blood tests.

DESIGN

In 2 different monitors, each conducted for 2 years, laboratory personnel in institutions enrolled in the College of American Pathologists (CAP) Q-Tracks program tracked the percentages of emergency department stat potassium results and/or the percentages of morning rounds routine test results that were reported later than self-imposed reporting deadlines.

SETTING

A total of 291 hospitals participating in 2 CAP Q-Tracks monitors.

RESULTS

Participants monitored 225,140 stat emergency department potassium TATs, of which 33,402 (14.8%) were outliers, and 1,055040 routine morning test reporting times, of which 123,554 (11.7%) were outliers. For both monitors, there was a significant (P <.05) downward trend in the outlier rates as the number of quarters in which participants submitted data increased.

CONCLUSION

Outlier reporting rates for emergency department stat potassium and routine morning test results decreased during the 2-year period of continuous monitoring. The CAP Q-Tracks program provides an effective vehicle by which providers of laboratory services may improve the timeliness with which they deliver the results of laboratory tests.

Serum tumour markers: from quality control to total quality management

Since the first clinical use of tumour markers, quality assurance has been considered only in a restrictive manner, that is, as a surveillance of the analytical process. In other words, quality assessment was roughly viewed as a synonymous with quality control. This is not surprising, since tumour markers are almost exclusively assayed by radioimmunoassays, whose analytical performance were suboptimal in the 1970s. Furthermore, tumour marker concentrations in biological fluids were very low (in the ng range); in addition, primary standards were not available and dose-response curves were set up with conventional calibrators. Therefore, quality control programmes have become mandatory to restrict intra- and inter-laboratory variability.

Operating room blood delivery turnaround time: a College of American Pathologists Q-Probe Study of 12647 units of blood components in 466 institutions

OBJECTIVES

To determine the normative distribution of time elapsed for blood bank personnel to fill nonscheduled operating room (OR) blood component orders in hospital communities throughout the United States, and to examine hospital blood bank practices associated with faster blood component delivery times.

DESIGN

Participants in the College of American Pathologists Q-Probes laboratory quality improvement program collected data prospectively on the times elapsed for blood bank personnel to fill nonscheduled emergent orders from hospital ORs for red blood cell (RBC) products, fresh frozen plasma (FFP), and platelets (PLTs). Participants also completed questionnaires describing their hospitals' and blood banks' laboratory and transfusion practices.

SETTING AND PARTICIPANTS

Four hundred sixty-six public and private institutions located in 48 states in the United States (n = 444), Canada (n = 9), Australia (n = 8), the United Kingdom (n = 4), and Spain (n = 1).

MAIN OUTCOME MEASURES

The median time elapsed between requests for blood components by OR personnel and the retrieval of those components by blood component transport personnel, and the median time elapsed between requests for blood components by OR personnel and the arrival of those components in ORs.

RESULTS

Participants submitted data on 12 647 units of RBCs, FFP, and PLTs. The median aggregate request-to-retrieval turnaround times (TATs) for RBCs, FFP, and PLTs ranged from 30 to 35 minutes, and the median aggregate request-to-arrival TATs for RBCs, FFP, and PLTs ranged from 33 to 39 minutes. Most of the TAT was consumed by events occurring prior to, rather than after release of components from blood banks. Shorter prerelease TATs were associated with having surgical schedules that listed patients' names and procedures available to blood bank personnel prior to surgeries, and having adequate clotted specimens in the blood bank and completed type-and-screen procedures performed before requests for blood components were submitted to blood banks. Among the fastest-performing 10% of participants (90th percentile and above), request-to-retrieval TATs ranged from 12 to 24 minutes for the 3 blood components, whereas among the slowest-performing 10% of participants (10th percentile and below), request-to-retrieval TATs ranged from 63 to 115 minutes for the 3 components. Median TATs ranged from 33 to 37 minutes for the 3 components. Institutions with TATs in the fastest-performing 25th percentile more frequently stored cross-matched RBCs in the OR daily, stocked PLTs for unexpected surgical use, stored PLTs in or near the OR, and had laboratory rather than nonlaboratory personnel deliver components to the OR than did those institutions with TATs in the slowest-performing 25th percentile.

CONCLUSIONS

Hospital blood bank personnel can deliver blood components to the OR in slightly longer than 30 minutes, measured from the time that those units are requested by OR personnel. Practices aimed at saving time before components are released from blood banks will be more efficient in reducing overall TAT than those practices aimed at saving time after components are released from blood banks. Specific practices associated with shorter blood delivery TATs included providing blood bank personnel with access to the names of surgical patients potentially requiring blood components, having pretransfusion testing completed on those patients prior to surgery, having ample blood products on hand, and having laboratory personnel control blood product delivery.

Quality indicators of blood utilization: three College of American Pathologists Q-Probes studies of 12,288,404 red blood cell units in 1639 hospitals

OBJECTIVES

To determine the normative rates of blood unit crossmatched to transfused (C:T) ratios, red blood cell (RBC) unit wastage, and RBC unit expiration that exist in hospital communities throughout the United States, and to examine hospital blood bank practices associated with more desirable (lower) rates.

DESIGN

In 3 separate studies, participants in the College of American Pathologists Q-Probes laboratory quality improvement program collected data retrospectively on the number of transfusion crossmatches performed in their institutions and the number of RBC-containing units that were transfused into patients, the number of units that expired (outdated) prior to being utilized, and the number that were wasted due to mishandling. Participants also completed questionnaires describing their hospitals' and blood banks' laboratory and transfusion practices.

SETTING AND PARTICIPANTS

One thousand six hundred thirty-nine public and private institutions, well more than 80% of which were known to be located in the United States.

MAIN OUTCOME MEASURES

Quality indicators of blood utilization (namely, the C:T ratio, the rate of RBC unit expiration, and the rate of RBC unit wastage).

RESULTS

Participants submitted data on 12,288,404 RBC unit transfusions. The C:T ratios were 1.5 or less in the top-performing 10% of participating institutions (90th percentile and above), 1.8 to 1.9 in the midrange of participating institutions (50th percentile), and 2.4 or greater in the bottom-performing 10% of participating institutions (10th percentile and below). Red blood cell unit expiration rates were 0.1% or less at the 90th percentile and above, 0.3% to 0.9% at the 50th percentile, and 3.5% or greater at the 10th percentile and below. Red blood cell unit wastage rates were 0.1% or less at the 90th percentile and above, 0.1% to 0.4% at the 50th percentile, and 0.7% or greater at the 10th percentile and below. Depending on which quality indicator was examined, lower values (ie, better performances) were found in institutions that had fewer than 200 hospital beds, no teaching programs, no on-site full-time medical directors of transfusion services, did not utilize maximum surgical blood order schedules, set C:T threshold goals of 2.0 or less, monitored categories of health care workers responsible for RBC wastage, monitored requests for RBC components by transfusion indication, did not accept short-dated units from blood distribution centers, and if they did accept short-dated units, were allowed to return those units to the distribution centers.

CONCLUSIONS

Hospital blood bank personnel can achieve C:T ratios below 2.0, RBC unit expiration rates below 1.0%, and RBC unit wastage rates below 0.5%. Lower C:T ratios and/or RBC unit expiration rates were associated with blood bank personnel setting C:T thresholds of 2.0 or less, monitoring requests for blood components by transfusion indication criteria, monitoring categories of health care workers responsible for blood wastage, not accepting short-dated units from blood distribution centers, and if short-dated units were accepted, being allowed to return those units to the blood distribution center. These practices were not associated with lower blood wastage rates.

Laboratory results. Timeliness as a quality attribute and strategy

Although timeliness of results reporting has not been a major focus in clinical laboratories, there is increasing pressure from clinicians to report results rapidly. Even though there are only sparse data, timeliness in reporting of laboratory results undoubtedly affects clinician and patient satisfaction as well as length of hospital stay. Improving turnaround time (TAT) is a complex task involving education, equipment acquisition, and planning. All the steps from test ordering to results reporting should be monitored and steps taken to improve the processes. Various strategies to improve TAT at each step in the testing process are discussed.

Morning rounds inpatient test availability: a College of American Pathologist Q-Probes study of 79860 morning complete blood cell count and electrolyte test results in 367 institutions

OBJECTIVES

To determine the success with which laboratories were able to report morning test results on time, the laboratory practice characteristics associated with improved success, and the degree of satisfaction among clinicians with the timeliness of laboratory service.

DESIGN

Hospital laboratories participating in the College of American Pathologist Q-Probes laboratory quality improvement program prospectively calculated the percentages of morning-run complete blood cell count (CBC) and electrolyte results that were reported on or before predetermined reporting deadlines, completed questionnaires concerning their departments' practice characteristics as they related to performing morning blood work, and distributed to physician utilizers of morning laboratory services questionnaires evaluating physician satisfaction with laboratory services.

SETTING AND PARTICIPANTS

A total of 367 public and private institutions located in the United States (355), Canada (5), Australia (2), and 1 each in the United Kingdom, Spain, Brazil, Korea, and Guam.

MAIN OUTCOME MEASURE

The percentages of morning-run CBC and electrolyte results reported on or before predetermined reporting deadlines.

RESULTS

Participants submitted data on 40 256 CBC and 39 604 electrolyte specimens. In aggregate, a total of 88.9% of these tests (90.2% of CBCs and 87.6% of electrolytes) were reported on or before the reporting deadlines that the participating laboratories set for themselves. Half of the participants reported 94.6% of their CBC results and 95.5% of their electrolyte results on or before their self-imposed reporting deadlines. No specific demographic features or departmental practice characteristics were associated with higher or lower rates of institutional reporting compliance. Most physician utilizers of early-morning laboratory test results believed that the laboratory is sensitive to and meets the needs of clinicians for timely reporting of early-morning test results.

CONCLUSIONS

Most laboratories are capable of reporting 95% of their routine morning laboratory tests on time, and most physicians are satisfied with their laboratories' morning testing service.

Using outlier events to monitor test turnaround time

OBJECTIVES

To determine the causes of excessive test turnaround time (TAT) and to identify methods of improvement by studying reasons for those tests reported in excess of 70 minutes from the time the test was ordered (ie, outliers).

DESIGN

Self-directed data-gathering of stat outlier TAT events from intensive care units and emergency departments, with descriptive parameters associated with each event and additional descriptive parameters associated with the participant.

PARTICIPANTS

Laboratories enrolled in the 1996 College of American Pathologists Q-Probes program.

MAIN OUTCOME MEASURES

Components associated with outlier TAT events and outlier TAT rates.

RESULTS

Four hundred ninety-six hospital laboratories returned data on 218 551 stat tests, of which 10.6% had TATs in excess of 70 minutes. Ten percent of stat emergency department tests and 14.7% of stat intensive care unit tests were outliers. Major areas in which delays occurred were test ordering, 29.9%; within-laboratory (analytic) phase, 28.2%; collection of the specimen, 27.4%; postanalytic phase, 1.9%; and undetermined, 12.5%. The type of test performed was a significant factor and was independent of location: Chemistry-Multiple Test appeared most frequently ( approximately 40%), followed closely by Hematology-Complete Blood Count (approximately 20%) and Chemistry-Single Test ( approximately 18%). Factors of outlier TAT components for intensive care unit specimens were identified using statistical modeling and included hour of day, type of health care personnel collecting specimen, performing the test in a stat laboratory, and reason for delay. Outlier rates were not associated with any identified factors. The practice parameters of laboratories with outlier rates in the lowest 10th percentile significantly differed from those with rates in the top 10th percentile in test request computerization, report methods, and ordering methods.

CONCLUSIONS

We observed that outlier analysis yields new information, such as type of test and reason for delay, concerning test delays when compared with TAT determination alone. Laboratories experiencing stat test TAT problems should use this tool as an adjunct to routine TAT monitoring for identifying unique causes of delay.

Medical, economic, and regulatory factors affecting point-of-care testing. A report of the conference on factors affecting point-of-care testing, Philadelphia, PA 6-7 May 1994

On 6-7 May 1994, the National Academy of Clinical Biochemistry sponsored a conference on point-of-care testing (POCT) in Philadelphia, PA. Several other organizations including the American Association for Clinical Chemistry, the Centers for Disease Control and Prevention, the Clinical Laboratory Management Association, the National Laboratory Training Network Eastern Area Resource Office, and Thomas Jefferson University co-sponsored the program, which brought together approximately 225 healthcare professionals involved in the decision making processes of implementing and overseeing POCT. These individuals included clinical chemists, medical technologists, clinicians, pathologists, nurse managers, respiratory therapists, laboratory and hospital administrators, and manufacturers of point-of-care devices. The conference focused primarily on the critical care setting, but some attention was given to the more general patient setting. The panelists assessed POCT from four perspectives: (1) medical aspects, (2) delivery options for achieving rapid turn-around time, (3) the economics of the different delivery options, and (4) legislative, regulatory, and legal issues. At the completion of the meeting, areas of agreement and disagreement were summarized. In addition, areas requiring further research and standardization were delineated. The impact of the conference on laboratory practices was evaluated by means of a questionnaire sent to hospital-based healthcare personnel approximately 6 months after the meeting.