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Turnaround time: how labs improve their performance.

Turnaround time: How labs improve their performance

One key to faster delivery of laboratory test results is the acquisition of new automated instruments. This step, mentioned by about a quarter of MLO's panelists, tops the list of successful efforts to reduce turnaround time. Another 9 per cent credit a related measure, computerization, with cutting TAT.

As Figure I shows, the second most effective strategy is a combination of educating personnel and exercising good management, cited by 21 per cent of the panelists. The remaining panel members say they had the highest TAT success with such moves as earlymorning testing, additional staffing, getting physicians to change their ordering patterns, and bringing send-out tests in-house.

There is no universal cure for turnaround time problems; what works for one laboratory can fail for another. For example, 15 per cent of the laboratories polled made no dent in TAT by trying to change physicians' ordering patterns.

Another 15 per cent have found it futile to meet on TAT with nurses and physicians, but most panelists report a different outcome: Eighty-four per cent held such meetings in the last three years-a big jump from the 64 per cent in MLO's 1980 turnaround time survey-and a large majority say the sessions helped improve turnaround time (Figure II).

Ten per cent of these labs meet monthly with other departments on tumaround time problems; 24 per cent, quarterly; and 7 per cent, annually. The rest, nearly 60 per cent, have met only once or twice in the last three years.

The most common meetings are with nurses (79 per cent of labs), followed by meetings with the medical staff (53 per cent) and the house staff (24 per cent). Eighty-nine per cent of laboratories have sent the lab manager to such meetings; 51 per cent, a pathologist; and 30 per cent, supervisors.

Among those that do not rely on meetings to tackle TAT problems, Kathy Moore, senior technologist at 49-bed St. Francis Memorial Hospital in West Point, Neb., says: "One-on-one communication works best here. If someone wants to know why a test takes so long, we tell them."

For example, doctors quit pressing for 10-minute digoxins once the laboratory explained that incubation alone is a 10-minute process. And now that nurses know a crossmatch takes 45 minutes, they no longer start pestering the lab for results 10 or 15 minutes after the specimen arrives. "We have a good relationship with the nurses," Moore comments. "I wouldn't have said that a year ago.,,

Fifty-six per cent of the laboratories surveyed, almost twice the 1980 proportion, compile reports on their tumaround time (Figure III). These are compared with previous reports for quality assurance and to assess scheduling, staffing, and instrument needs. The reports are also shown to other departments.

In addition, 46 per cent of the labs-up ftom 30 per cent in 1980-distribute guidelines on test tumaround times (see Figure IV for excerpts). Telling physicians and nurses how long they can expect to wait is supposed to minimize anxious phone calls for results. As some panelists point out, however, the guidelines often are not consulted.

Turnaround time at 234-bed Roseville (Calif.) Community Hospital improved considerably after the laboratory 1) hired additional accessioning personnel to speed up order entry and result reporting, and 2) worked with other departments to revamp collection procedures.

Phlebotomy rounds increased to every two hours, which cut down on Stat requests. Phlebotomists still make special trips for true emergencies or a timed-test collection. In certain units-intensive care, coronary care, and labor and delivery-the nurses routinely handle Stat specimen collection. They start drawing at 4 a.m. on the ICU and CCU, which enables the lab to issue test reports by 7 a.m.

At 28-bed St. Mary's Hospital in Cottonwood, Idaho, physicians joined with the laboratory and persuaded administration to replace outdated instrumentation. The results: lower turnaround time, increased lab utilization, and added revenue.

Cynthia Glover, laboratory supervisor, says turnaround on send-out blood gases was so slow doctors didn't even bother ordering the test through the lab. Once the hospital bought its own blood gas analyzer, the test volume climbed sharply. "We performed 65 blood gases in the first six months we had the instrument, compared with just half a dozen tests the entire year before," Glover recalls.

After the laboratory replaced its flame photometer with an electrolyte analyzer, turnaround time on Stat potassiums dropped from 35 minutes to less than two minutes.

A New Mexico panelist conducted a study on slow send-out test results. "I kept a log for two months last spring and compared the actual turnaround time with what the reference laboratory promised in its literature," says Jeff Morris, administrative laboratory director at 144-bed Guadalupe Medical Center in Carlsbad. He found the reference lab was late with more than 10 per cent of its test results.

"Physicians don't care what the problem is, they just want to see it fixed," Morris notes. In this case, the test results were often ready to go on time but would somehow get held up in delivery to the hospital lab.

Morris's study prompted the reference laboratory to keep a tighter watch on the reporting process and to begin calling clients to verify the receipt of results. The delays stopped last year, but Morris conducts random checks to make sure the situation stays under control.

A faulty pneumatic tube system and delayed charting on the nursing floors create turnaround-time headaches for the laboratory at the 180-bed Beloit (Wis.) Memorial Hospital. "The tube system malfunctions daily, and the joke around here is that there must be a burial ground somewhere full of lab reports," laboratory director Noreen Glatt comments.

Even when the reports do make it through, the test results aren't always charted promptly, Glatt learned after several visits to the floors. It wasn't uncommon to see reports the laboratory had delivered at 7 a.m. still sitting on the nursing desk at 8 at night. Meanwhile, doctors had been calling the laboratory all day for their results.

Glatt began personally charting the microbiology test results as an experiment. "Phone calls and complaints decreased dramatically once the results were charted in a timely manner," she says"The ideal solution would be a laboratory computer system linked to all the nursing stations, but that's at least two years off for us."

In the meantime, Glatt and the vice president of nursing have formulated a workable compromise. "I have submitted a proposal asking for 1.5 clerical FTEs to do all the charting," she says. This will place test-result charting responsibility with the laboratory and greatly reduce the clerical burden on nursing which is a big selling point.

"The lab will continue to call the floors with panic values or anything else that might affect patient care, so nursing needn't worry about missing a significant test result," Glatt explains. "The rest of the lab data iwill be available on the chart, which nurses should be reviewing several times during each shift."

The laboratory at 650-bed North Mississippi Medical Center in Tupelo faced heavy demand for early-moming draws ordered Stat so that results would be ready in time for rounds. To ease the pressure, the lab guaranteed 7 a.m. delivery of results on such tests as glucose, creatinine, BUN, complete blood count, electrolytes, PT, and PTT. Now, instead of ordering last-minute Stats that interrupt the lab work flow, physicians simply check "order by 7 a.m. " on the requisition form.

The laboratory made good on its promise by reassigning some of its 94 FTEs to handle the large number of 5 a.m. draws. The collectors commonly draw 75 patients in the wee hours. This translates into some 75 CBCs, 50 chemistry profiles, 20 PTTs, and 20 PTs, with all the results charted before breakfast. "We offer excellent TAT more than 99 per cent of the time-it's the exceptions that cause the flak," Rick Tucker, assistant administrative director, comments.

The laboratory at a mediumsize California hospital has shortened tumaround time a good deal by working closely with other hospital services. An exception is the emergency room. "Our worst failure has been trying to get the ER staff to draw its own specimens," a lab staff member comments.

The nurses don't understand the importance of labeling and following proper collection techniques, she says, adding: "We get lots of hemolyzed specimens and often have to go back down for a second draw or to identify the patient." The lab staff resents the interruption, and the ER staff bristles at the further delay in obtaining test results. "We haven't figured out how to solve this problem, but we're working on it."

Whether pleased by their successes or disappointed by their failures on turnaround time, 75 per cent of the panelists believe there is room for improvement (Figure V). Procedures most often cited as candidates for 'improvement include the CBC, chemistry profiles, electrolytes, glucose, urinalysis, and drug testing. Not surprisingly, almost half of those responding expect a major assist ftom more sophisticated instruments or computers.

Laboratorians need all the help they can get. As one 3- 11 shift supervisor put it, "The biggest failure in my lab has been trying to do more than 12 things at once."
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Title Annotation:special report, part 2
Author:Hallam, Kris
Publication:Medical Laboratory Observer
Date:Aug 1, 1988
Words:1533
Previous Article:Turnaround time: speeding up, but is it fast enough?
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