Routine outpatient laboratory test turnaround times and practice patterns: a College of American Pathologists Q-Probes study

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.

Laboratory turnaround times in response to an abrupt increase in specimen testing after a natural disaster

OBJECTIVES

Understanding how key indicators change during extreme circumstances could help laboratories maintain high standards when responding to disasters. We assessed the effects of an earthquake on turnaround times (TATs) at a hospital laboratory.

METHODS

We examined TATs for 709,786 potassium tests and 196,795 urine cultures from February 2010 to January 2013. Hospital and community data were evaluated separately and compared during the transport, registration (accessioning), and analysis time phases.

RESULTS

After the earthquake, the laboratory undertook approximately 70% of the nonacute community specimen testing. Initially, community transport times increased by 20 to 27 hours and remained 2 to 3 hours above prequake levels. Registration time increased by 10 to 20 minutes (hospital) and 30 to 45 minutes (community) for a short period. During the initial few months, community urine culture analysis time increased by more than 50 hours.

CONCLUSIONS

The increase in specimen numbers affected short- and long-duration test TATs differently. Streamlining and automating processes reduced registration and analysis times. Increased transport time was outside the control of the laboratory.

Mapping turnaround times (TAT) to a generic timeline: a systematic review of TAT definitions in clinical domains

BACKGROUND

Assessing turnaround times can help to analyse workflows in hospital information systems. This paper presents a systematic review of literature concerning different turnaround time definitions. Our objectives were to collect relevant literature with respect to this kind of process times in hospitals and their respective domains. We then analysed the existing definitions and summarised them in an appropriate format.

METHODS

Our search strategy was based on Pubmed queries and manual reviews of the bibliographies of retrieved articles. Studies were included if precise definitions of turnaround times were available. A generic timeline was designed through a consensus process to provide an overview of these definitions.

RESULTS

More than 1000 articles were analysed and resulted in 122 papers. Of those, 162 turnaround time definitions in different clinical domains were identified. Starting and end points vary between these domains. To illustrate those turnaround time definitions, a generic timeline was constructed using preferred terms derived from the identified definitions. The consensus process resulted in the following 15 terms: admission, order, biopsy/examination, receipt of specimen in laboratory, procedure completion, interpretation, dictation, transcription, verification, report available, delivery, physician views report, treatment, discharge and discharge letter sent. Based on this analysis, several standard terms for turnaround time definitions are proposed.

CONCLUSION

Using turnaround times to benchmark clinical workflows is still difficult, because even within the same clinical domain many different definitions exist. Mapping of turnaround time definitions to a generic timeline is feasible.

Laboratory medicine quality indicators: a review of the literature

We summarize information on quality indicators related to laboratory testing from published literature and Internet sources to assess current gaps with respect to stages of the laboratory testing process, the Institute of Medicine (IOM) health care domains, and quality measure evaluation criteria. Our search strategy used various general and specific terms for clinical conditions and laboratory procedures. References related to a potential quality indicator associated with laboratory testing and an IOM health care domain were included. With the exception of disease- and condition-related indicators originating from clinical guidelines, the laboratory medicine quality indicators reviewed did not satisfy minimum standard evaluation criteria for quality or performance measures (ie, importance, scientific acceptability, and feasibility) and demonstrated a need across the total laboratory testing process for consistently specified, useful, and evidence-based, laboratory-related quality and performance measures that are important to health outcomes and meaningful to health care stakeholders for which laboratories can be held accountable.

“Turnaround time”: a new parameter for the characterization of the overall efficacy of laboratory diagnostic processes

Bevezetés:A szerzők a laboratóriumi diagnosztikai tevékenység hatékonyságát jellemző paraméter, az ún. „turnaround time” meghatározására alkalmas számítógépes programot dolgoztak ki laboratóriumukban. A turnaround time a minta laboratóriumba való beérkezése és az orvosi validálást követő eredménykiadás között eltelt idő, mely jól jellemzi az eredménykiadás hatékonyságát, és ezért a laboratóriumok működésének fontos minőségügyi paramétere.Módszer:Analízisük során a sürgős, rutin- és speciális vizsgálatokat külön kezelve 6 hónap adatait dolgozták fel, és a turnaround time medián, 5- és 95-percentil értékeit adták meg. Meghatározták emellett a maximálisnak definiált turnaround time értéket (sürgős 1 óra, rutin 4 óra, speciális 2–14 nap) meghaladó turnaround time értékű vizsgálatok („kiesők”) arányát is az összes vizsgálati számra vonatkoztatva.Eredmények:A sürgős vizsgálatok esetében a medián turnaround time 9–70 perc, a rutinvizsgálatoknál pedig 33–190 perc között volt. A speciális vizsgálatok jóval heterogénebb képet mutattak, és általában megállapítható volt, hogy a kis mintaszámú, nem automatizált, immunkémiai és hemosztázis-tesztek esetében magas a turnaround time értéke és a kiesők aránya. A rutinvizsgálatok longitudinális analízise egyértelműen mutatta, hogy 2006 első félévében javultak a vizsgálatok turnaround time értékei a laboratórium valamennyi részlegén. A turnaround time hosszát befolyásoló egyik lényeges paraméter az orvosi validálás ideje, ami jelentősen csökkenthető egy autovalidáló program segítségével. A szerzők adatai alapján az autovalidálás bevezetése akár 1–2 órával is csökkentette a rutinvizsgálatok medián turnaround time értékeit. Az alkalmazott számítógépes program alkalmas akár a mintaszállítás effektivitásának jellemzésére is, amit a szerzők két különböző mintaszállítási infrastruktúrával rendelkező sürgősségi részlegük összevetésével mutattak be.Következtetések:Az itt ismertetett turnaround time analízis az általános rutin része a világ fejlettebb országaiban tevékenykedő diagnosztikai laboratóriumokban, ugyanakkor az első ilyen próbálkozást jelenti Magyarországon.

Five-year follow-up of routine outpatient test turnaround time: a College of American Pathologists Q-Probes study

CONTEXT

Timely reporting of outpatient tests can increase efficiency of care and improve customer satisfaction.

OBJECTIVES

We conducted a survey in 2002 to determine how quickly hospital-based laboratories turned around routine requests for 3 common assays and compared the results with a similar survey conducted in 1997.

DESIGN

One hundred eighteen laboratories prospectively recorded the collection-to-verification turnaround time for 9252 complete blood cell counts (CBCs), 8832 thyroid tests, and 9193 basic metabolic panels.

RESULTS

The median facility reported all test results by 7:00 am of the weekday immediately after the date of specimen collection. The bottom 10% of institutions reported 99% of CBCs and basic metabolic panels within 1 day and 60% of thyroid tests within 1 day. The 65 institutions that participated in both the 1997 and 2002 surveys showed significant overall improvement in turnaround time for all 3 types of tests (P <.001). In 2002, federal institutions had significantly slower turnaround times than nonfederal institutions for CBC tests (P <.001), thyroid tests (P =.03), and basic metabolic panels (P <.001). Other demographic and practice variables were not associated with turnaround time.

CONCLUSION

The turnaround time of routine outpatient tests appears to have improved between 1997 and 2002.