Turnaround time for the issuing of packed red cells: A retrospective study in a tertiary care hospita

Introduction: Turnaround time (TAT) is one of the most crucial performance indicators for blood transfusion and laboratory services. It is especially crucial in transfusion services due to its seminal role as a determining factor in patient care outcomes. We examined our institution’s TAT for issuing blood units. Materials and Methods: The Department of Immunohematology and Blood Transfusion, MGM Medical College and Hospital in Navi Mumbai, Maharashtra, India, undertook this retrospective noninterventional study over 12 months from January 01, 2020 to December 31, 2020. TAT was determined using a random audit of 10% of all monthly requests at the blood center. All requests for packed red cells (PRCs) received in the blood center during the study period were included in the evaluation. All requests for other blood components such as fresh-frozen plasma, random donor platelets, and cryoprecipitates were excluded along with all reservations for PRCs. A team of investigators tracked 369 requests for packed red cells over the year, noting the turnaround time. The standard TAT was set depending on the nature of the clinical case. Any significant deviation from institutionally established TAT was investigated, and root cause analysis was done. Results: The majority of transfusion requests were routine (72%) followed by emergency (23%) and lifesaving (5%). For routine cases, the average TAT was observed at 104 minutes. For emergency cases, the average TAT was observed at 39 minutes. For lifesaving cases, the average TAT was observed at 12 minutes. The highest number of cases were categorized under routine, followed by emergency cases and lifesaving categories. Conclusion: It was observed that there were no significant variations in turnaround time in routine, emergency, or lifesaving cases. Overall, as per our blood center standards, TAT for the issue of packed red cells was observed to fall under the normal range for routine, emergency, and lifesaving. Any outliers observed during the duration of the study were mainly due to inadequate samples or patient details received at the blood center or the presence of irregular antibodies encountered during the crossmatch.

Analysis of external quality assessment results of quality indicators for national emergency examination turnaround time / 中华检验医学杂志

Objective:To establish preliminary quality specifications for emergency examination turnaround time (TAT).Methods:The National Center for Clinical Laboratories organized 31 provinces (autonomous regions and municipalities directly) and Xinjiang production and Construction Corps centers to launch a synchronous Quality Indicators (QIs)-External Quality Assessment (EQA) program and the collected data were reported via developed online EQA system. The essential information of the clinical laboratories, the data of pre-examination and intra-laboratory TAT quality indicators of emergency departments at each specialty (biochemistry, automatic immunity, three routines tests and coagulation) and four specific tests (blood potassium, troponin I/T, white blood cell count and international normalized ratio (INR)) were collected from 2019 to 2021. TAT returned the median and 90th percentile ( P90) of the specified month were calculated. The median (lower quartile, upper quartile) of the TAT returned laboratories were calculated and second result grading statistics for 2021 (2 422 tertiary hospital and 5 088 secondary hospital) were performed to understand the difference of pre-examination and the laboratory TAT between different tertiary hospitals. Results:From 2019 to 2021, there were 9 540 laboratories, 9 709 laboratories and 10 653 returned laboratories. The pre-examination TAT of each specialty was similar, and the results were relatively stable. The median distribution was about 15 (10, 30) min, and the monthly P90 distribution was about 20 (10, 30) min. The distribution results of the median intra-laboratory TAT in each specialty were as follows: automatic immunity≥biochemistry>coagulation>three routine tests. The distribution of the latest (second result in 2021) survey results of each specialty were as follows: automatic immunity 53 (30, 60) min, biochemistry 45 (30, 60) min, coagulation 30 (23, 40) min, and three routine tests 20 (11, 30) min. The median results of monthly P90 of intra-laboratory TAT were as follows: 60 min for automatic immunity and biochemistry specialty, about 38 min for coagulation specialty, and about 27 min for three routines tests. The hierarchical statistical results showed that the monthly P90 distribution of laboratory TAT of the pre-examination and intra-laboratory TAT from the tertiary hospital was higher than that of the secondary hospital. The pre-examination TAT of each specialty of the tertiary hospital/secondary hospital was as follows: biochemistry 35 (22, 60)/20 (11, 30) min, automatic immunity 33 (20, 60)/20 (10, 30) min, three routine tests 30 (20, 49)/20 (10, 30) min and coagulation 31 (20, 58)/20 (10, 30) min, the intra-laboratory TAT of each specialty of the tertiary hospital/secondary hospital was as follows: biochemistry 65 (50, 91)/60 (40, 70) min, automatic immunity 75 (55, 113)/60 (40, 90) min, three routine tests 30 (23, 38)/28 (19, 30) min and coagulation 53 (36, 72)/35 (30, 57) min. In terms of the distribution results of the median of intra-laboratory TAT of the four specific tests, 96.76% (9 484/9 801) of the blood potassium and 95.96% (8 733/9 101) of the troponin I/T medical institutions were TAT within 69 min in the laboratories, 95.34% (9 679/10 152) of the white blood cell count medical institutions were TAT within 31 min in the laboratories, and 98.85% (9 462/9 572) of the INR medical institutions were TAT within 66 min in the laboratories. Conclusions:This survey provides a preliminary quality specification for the emergency department turnaround time at each specialty. Lower quartile, median and upper quartile of the monthly P90 at the tertiary and secondary hospitals can be used to define the best, appropriate and minimum performance levels, respectively.

Evaluation of the effectiveness of Lean Six Sigma Approach for SARS-CoV-2 RT-PCR Turnaround Time (TAT) improvement at a hospital-based tertiary laboratory

OBJECTIVES@#This study aims to evaluate the effectiveness of the Lean Six Sigma approach in improving procedure for (TAT) of reverse transcriptase polymerase chain reaction (RT-PCR) for SARS-CoV-2 testing at The Medical City. Specific objectives of the study are to determine the following: 1) baseline sigma and average TAT (in hours); 2) post-implementation sigma and average TAT (in hours) 3) compare if there is a significant improvement between baseline and post-implementation sigma and average TAT (in hours) 4) effect on workflow efficiency.@*METHODOLOGY@#Lean Six Sigma method for quality improvement was applied using DMAIC: Define, Measure, Improve, and Control. The root causes identified were lack of manpower, equipment, space, and manual and complex processes. Then, process wastes were identified, and corresponding proposed solutions were sustained in the control phase, such as standardization and the use of automation. Measurement of turn-around time and six sigma of the process were performed for evaluation.@*RESULTS@#Results showed a significant improvement in the TAT in RT-PCR results, with most results released within 24 hours. The pre-Lean Six Sigma data on TAT were as ollows: 24.88% released within 24 hours; 65.14% released within 24-48 hours; 3.56% released within 48-72 hours, and 6.42% released in more than 72 hours. The post Lean Six Sigma TAT were as ollows: 95.32% released within 24 hours; 4.29% released within 24 to 48 hours; 0.13% released within 48-72 hours, and 0.12% released more than 72 hours. The computed sigma post-implementation was increased from 3.56 to 4.82. The p-value was calculated using the chi-square test, and the computed chi-square statistic is 1894.1021. The p-value is <0.00001 and the result is significant at p<.05. Although there is a significant decrease in the volume of samples post implementation due to the changing COVID-19 situation, real time TAT was improved. It also resulted to increased workflow efficiency with the use of lesser manpower with more appropriate utilization.@*CONCLUSION@#Applying the Lean Six Sigma method to improve quality processes in the laboratory is shown to be practical, cost-effective, and straightforward.

Discussion on the new mode of blood isolation and batch release / 中国输血杂志

【Objective】 To compare the effectiveness of the old mode of blood isolation and batch release (the old mode) and the new mode in Chengdu, so as to provide basis for optimizing working strategy. 【Methods】 1) The blood testing report was released one by one in the old mode but released uniformly in accordance with the blood batches classified by blood storage and supply department in the new mode. 2) In the old mode, apheresis platelet samples were detected by serological testing first and nucleic acid testing(NAT) later, and whole blood samples were reasonably arranged according to blood inventory and detection workload. In the new mode, platelets samples collected within our center headquarters were detected by serological test and NAT simultaneously, while those collected outside the center complied with the old strategy. As for whole blood, the same batch samples classified by blood storage and supply department should be arranged to the detection line with the fewest samples.3) The turnaround time(TAT) in the laboratory (referred to as sample TAT) and the TAT in the blood to-detect stock (referred to as blood TAT) in two phases(year 2016 vs 2018, pre- and post- the new mode), involving 164 748 and 179 488 blood samples, were compared by SPSS25.0 software. The constituent ratio of the TATs were compared with Chi-square test, and the difference of blood TAT between old and new mode were compared with Mann-Whitney U test. 【Results】 1) Significant difference was noticed in constituent ratio of TATs between old and new mode (P<0.05). 2)The blood TATof apheresis platelets using the new mode was 0.95(QR: 0.22)days, with the median 0.20 days shorter than that the old mode.. The blood TAT of whole blood in the new mode was 3.77 (QR: 1.99) days, with the median 0.90 days shorter than that in the old mode, and the difference was statistically significant (P<0.05). 【Conclusion】 Compared with the old mode, the new mode showed the following advantages: 1) It can realize the unified issuing of testing reports of blood with the same batch, contribute to the early discovery of errors that occurred during blood donation process, and located the errors wihin intra-batches for investigation. 2) It can advance the issuing of blood testing reports of the same batch. 3) It can make the flow of samples and blood with the same batch between different departments more standardized and orderly, and optimize the process of blood sorting thus shortening blood TAT. 4) It can realize the counting and checking of samples, within the same batch, at different states, so as to minimize the error issuing of unqualified blood and to-detect blood, and is more conducive to ensure the quality, safety and timely supply of blood.

Effect evaluation of optimizing blood culture testing process / 中华检验医学杂志

Objective:To evaluate whether the time to positive (TTP), handling time after positive alarm and turnaround time (TAT) of bacteremia blood culture can be shortened by optimizing blood culture workflow.Methods:This study was conducted retrospectively. Positive blood culture samples collected from Peking University People′s Hospital from January 1, 2014 to June 30, 2021 were analyzed in stages. In the traditional process stage of this study (2014), 502 bottles of positive blood culture samples were included in the analysis. In the first stage of process optimization (2016), the working time of staff was increased to 22:00, and 976 positive blood culture specimens were included in the analysis. In the second stage of process optimization (2018), the rapid identification process of MALDI-TOF MS was added, and a total of 1 029 bottles of positive blood culture samples were included. In the third stage of process optimization (2020) with the introduction of the new VIRTUO BACT/ALERT system. The difference of TTP, handling time after positive alarm and TAT of whole process in different stages of traditional process and process optimization were compared. All data were statistically significant when P<0.05 using rank-sum test. Results:In the traditional process stage (2014), the median quartile time of handling time after positive alarm was 55.70 (47.35, 68.45) h. In the first stage of process optimization (2016), the median quartile time of handling time after positive alarm was 47.25 (33.88, 59.96) h, and the handling time after positive alarm in the first stage of process optimization was significantly shorter than that in the traditional process stage ( Z=?10.734, P<0.001). In the second stage of process optimization (2018), the median quartile time for handling time after positive alarm was 47.18(36.41, 59.40) h, and 12.18% of the preliminary identification results of Gram-negative bacilli before 17:00 could be reported to the clinic before audit. In the third stage of process optimization (2020), the median quartile of TTP and TAT were 39.56 (21.52, 62.65) h and 78.16(64.68, 99.72) h respectively in the original BACT/ALERT 3D system. The new VIRTUO BACT/ALERT system had a median quartile of 37.03(21.08, 58.22) h for TTP and 73.41(62.88, 89.48) h for TAT. VIRTUO BACT/ALERT 3D had a significantly shorter TTP than BACT/ALERT 3D ( Z=?2.273, P=0.023), the TAT of VIRTUO BACT/ALERT system was significantly shorter than that of BACT/ALERT 3D system ( Z=?4.040, P<0.001). Conclusion:By improving the blood culture process of microbiology laboratory in many aspects and measures, the processing time of blood culture in each stage can be shortened and clinical benefits can be obtained.

An Analysis of Preanalytical Errors and Turnaround Time in Emergency Biochemistry Laboratory in a Tertiary Care Hospital in New Delhi

In modern diagnostics, it is extremely important to maintain and ensure quality of laboratory results dispatched. It is part of the total quality management and an essential criterion for accreditation of the laboratory. The analysis of biochemistry samples can be broadly divided into three phases: pre-analytical, analytical and post-analytical phase. We wanted to identify the commonly occurring pre-analytical errors and determine the turnaround time in the emergency biochemistry laboratory at a tertiary care hospital in Delhi.METHODSA cross-sectional study was done on a total of 2,73,111 samples received in the emergency biochemistry laboratory from September 2018 to August 2019 and an analysis of occurrence of pre-analytical errors was done, retrospectively. Additionally, the turnaround time of the laboratory was evaluated over a period of two months from July 2019 to August 2019 and average time was recorded. Data was collected from entry registers and rejected samples registers.RESULTSIn this study it was found that 10.58 % of the total samples received were rejected. Moreover, overall turnaround time was found to be 108 minutes (median value). In the present study, haemolysis was the most common reason for sample rejection. (63.14% of total rejections). Additionally, the second most common error was inadequate samples. 6570 samples were rejected due to this reason (22.73%).CONCLUSIONSHaemolysis was the most common cause of rejection in the emergency biochemistry laboratory. Also, it was seen that the most time-consuming step was analysis in auto-analyser with respect to contribution to turnaround time. As a matter of fact, Pre-analytical errors can adversely affect the treatment of patients. However, most of the errors can be reduced by proper training of the staff and checking competency thoroughly by conduction of practical and theory assessment of laboratory personnel at frequent intervals

Improvement of Urgent Tests Laboratory Turnaround Time Through Laboratory Lean Management

@#Introduction: Laboratory turnaround time (LTAT) is considered a reliable indicator of the quality and efficiency of a laboratory’s service. LTAT achievement, particularly of urgent tests, remains unsatisfactory and challenging in many clinical laboratories especially in tertiary health care centres with high workload and restricted resources. The unresolved issue of unsatisfactory urgent renal profile (RP) LTAT below the standard performance goal prompted our interest to improve laboratory’s handling of urgent test request. We thus implemented the Lean principle in the management of urgent test requests using urgent RP as the test model. Methods: The implementation of laboratory Lean involved 4 steps process; (1) Development of burning platform for change (2) Identification of waste (3) Planning and implementation of control measures (4) Measuring, monitoring, and sustaining the improvement. Urgent RP LTAT and the percentage of the request met the time requirement determined based on the data extracted from laboratory information system (LIS) before and after the implementation of Lean was compared to assess the effectiveness. Results: Urgent RP LTAT after the implementation of Lean was reduced i.e 35 min (before) vs 31 min (after), with the percentage of LTAT met the time requirement was significantly increased above the set target i.e 82.8% (before) to 93.5% (after) with P-value = 0.001. Conclusion: Implementation of innovation using Lean management has significantly improved urgent RP LTAT achievement, thus optimised urgent test management in our Chemical Pathology laboratory. Lean is a strongly recommended strategy to improve urgent test LTAT especially in laboratories with restricted resources.

Comparison Between the SFTS-QS Kit and the PowerChek SFTSV Real-time PCR Kit for the Detection of Severe Fever With Thrombocytopenia Syndrome Virus

The recent increase in severe fever with thrombocytopenia syndrome (SFTS) cases has led to the development of the SFTS-QS kit (MiCoBioMed, Seongnam, Korea) for detecting the SFTS virus (SFTSV, now renamed Huaiyangshan banyangvirus). SFTS-QS is a qualitative real-time reverse transcription PCR assay based on lab-on-a-chip technology. We evaluated the performance of the SFTS-QS kit and compared it with that of the PowerChek SFTSV Real-time PCR kit (PowerChek; Kogene Biotech, Seoul, Korea). A total of 117 serum samples were simultaneously assayed using the SFTS-QS and PowerChek kits. Sanger sequencing targeting the S and M segments of SFTSV was performed as the reference method. The total turnaround time of the two kits was compared. The SFTS-QS results agreed with those of PowerChek with a kappa value of 0.92. The diagnostic sensitivity and specificity of the SFTS-QS kit were both 100% (14/14 and 103/103, respectively), whereas those of the PowerChek kit were 100% (14/14) and 98.1% (101/103), respectively. The results of SFTS-QS and PowerChek were comparable; however, the SFTS-QS kit required a shorter total turnaround time. The SFTS-QS kit produced accurate and fast results and thus could serve as a useful tool for detecting SFTSV.

Investigation on the specimens′ turnaround time in clinical laboratories of Shaanxi Province / 临床检验杂志

Objective@#To investigate the turnaround time (TAT) of clinical laboratory specimens in Shaanxi Province, and provide evidence for improving quality of laboratories. @*Methods@#The 90th percentiles of pre-analytical TAT and intra-laboratory TAT of emergency and inpatient specimens from four majors, such as biochemistry, immunology, blood-urine-faces routines and blood coagulation, were filled in by laboratories on-line, and the returned data were analyzed by Excel 2007 and SPSS 17.0 software. The comparison of the data between two groups was performed with Mann-Whitney U test, and that from multiple groups by Kruskal-Wallis H test. @*Results@#A total of 267 questionnaires were issued, and 91.0% of laboratories finished the fill-in. Among them, 138 laboratories filled in the specimens′ TAT completely. There was no statistical difference in pre-analytical TAT of emergency specimens from four majors (P＞0.05), and the pre-analytical TAT was within 45 minutes in more than 85% of laboratories. There was significant difference in pre-analytical TAT of inpatient specimens from four majors (P＜0.05), and the pre-analytical TAT was within 120 minutes in 80% of laboratories. The specimens′ TAT of blood-urine-faces routines was slightly shorter than that of immunology. No matter emergency or inpatient specimens, the pre-analytical TAT of four majors in the laboratories of the second-level hospitals was less than that in the third-level hospitals (P＜0.05). Whether emergency or inpatient specimens, there were significant differences in the intra-laboratory TAT of four majors (P＜0.05). The intra-laboratory TAT of blood-urine-faces routines was the shortest, followed by that of blood coagulation and biochemistry, and that of immunology was the longest. The intra-laboratory TATs of emergency specimens for biochemistry, immunology, blood-urine-faces routines and blood coagulation were 30-120 minutes, 30-180 minutes, within 60 minutes and 15-120 minutes respectively, in 80% of laboratories. The intra-laboratory TATs of inpatient specimens for blood-urine-faces routines and blood coagulation were within 120 minutes and within 180 minutes respectively, in 80% of laboratories, while those for biochemistry and immunology were equal or greater than 240 minutes and 300 minutes respectively, in 20% of laboratories. No matter emergency or inpatient specimens, there was no significant difference in intra-laboratory TAT between the second-level hospitals and the third-level hospitals (P＞0.05). @*Conclusion@#The TAT of clinical laboratory specimens in Shaanxi Province is quite different. Some laboratories need to optimize the specimens′ turnaround process and shorten the TAT of specimens.

A multi-center research on the establishment and validation of autoverification rules for blood analysis / 中华检验医学杂志

Objective@#To establish a set of rules for autoverification of blood analysis, in order to provide a way to validate autoverification rules for different analytical systems, which can ensure the accuracy of test results as well as shorten turnaround time (TAT) of test reports.@*Methods@#A total of 34 629 EDTA-K2 anticoagulated blood samples were collected from multicenter cooperative units including the First Hospital of Jinlin University during January 2017 to November 2017. These samples included: 3 478 cases in Autoverification Establishment Group, including 288 cases for Delta check rules; 5 362 cases in Autoverification Validation Group, including 2 494 cases for Delta check; 25 789 cases in Clinical Application Trial Group. All these samples were analyzed for blood routine tests using Sysmex XN series automatic blood analyzers.Blood smears, staining and microscopic examination were done for each sample; then the clinical information, instrument parameters, test results and microscopic results were summarized; screening and determination of autoverification conditions including parameters and cutoff values were done using statistical analysis. The autoverification rules were input into Sysmex Laboman software and undergone stage Ⅰ validation using simulated data, and stage Ⅱ validation for post-analytical samples successively. True negative, false negative, true positive, false positive, autoverification pass rate and passing accuracy were calculated. Autoverification rules were applied to autoverification blood routine results and missed detection rates were validated, and also data of autoverification pass rate and TAT were obtained.@*Results@#(1)The selected autoverification conditions and cutoff values included 43 rules involving WBC, RBC, PLT, Delta check and abnormal characteristics. (2)Validation of 3 190 cases in Autoverification Establishment Group showed the false negative rate was 1.94%(62/3 190)(P<0.001), autoverification pass rate was 76.74%, passing accuracy was 97.47%; Validation of 2 868 cases in Autoverification Validation Group, the false negative rate was 3.38%(97/2 868)(P=0.002), autoverification pass rate was 42.26%, passing accuracy was 92.00%; Validation of Delta check on 288 cases in Autoverification Establishment Group and 2 494 cases in Autoverification Validation Group showed the false negative rates were respectively 1.39% and 2.61%(P<0.001). (3)Three hospitals adopted these rules of autoverification for 25 789 blood routine samples, and found that the average TAT of blood routine test reports were shortened by 24min, 32min and 7min respectively, the rate of samples reported within 30min were elevated by 33%, 53% and 7%. The autoverification pass rates were 72%-74%.@*Conclusions@#The application of this set of 43 autoverification rules in blood sample analysis can ensure test quality while shortenTAT and improve work efficiency. It is worth pointing out that for the same analytical systems in this research, validation is necessary before application of this set of rules, and periodic validation is required during application to make necessary adjustment; for different analytical systems, as this research provide a way to establish autoverification rules for blood routine tests.Clinical labs may establish their own suitable autoverification rules on the basis of technological parameters. (Chin J Lab Med, 2018, 41: 601-607)

Reduction Plan of ‘Undeterminable’ in the Unexpected Antibody Screening by the Microcolumn Agglutination Automated Instrument / 대한수혈학회지

BACKGROUND: Among the results of an unexpected antibody screening test using IH-1000, ‘undeterminable’ results can be obtained. Repeated tests not only use reagents and consumables but also cause a turnaround time delay. Therefore, it is important to reduce the ‘undeterminable’ results and to determine the effects. METHODS: From January to early June, 2016, 2,872 cases/259,455 tests (1.11%) of ‘undeterminable’ were detected in the screening test. The factors considered to affect the ‘undeterminable’ were classified into four categories: ① reagent, ② consumables, ③ inspection environment & specimen, and ④ enhancing the equipment management. For data comparison, a chi-square test was conducted (95% confidence interval, 0.05 significant level). RESULTS: The incidence of ‘undeterminable’ cases decreased from 1.11% before management to 0.66% (P < 0.001) after Pool Cells management. The consumption of ‘LISS/Coombs Card’ decreased from 1.07% before management to 0.51% (P < 0.001) after management. By maintaining a clean inspection environment and strengthening sample management, the rate decreased from 1.11% before management to 0.66% (P < 0.001) after management. On the other hand, there was no difference in the incidence of ‘undeterminable’ between before and after IH-1000 management reinforcement. CONCLUSION: Among the factors predicted to affect the decrease in the incidence of ‘undeterminable’, the management of Pool Cells and keeping the inspection environment clean as well as improving sample management contributed the most to the reduced ‘undeterminable’. Improvements in the management of consumables, and removing dust from the inside of the equipment, had a positive impact. A continuous quality improvement theme has been adopted and it is helpful for managing and improving the predicted factors.

Effects of lean management on emergency biochemistry test turnaround time in clinical laboratories / 临床检验杂志

Objective To investigate the effect of lean management on emergency biochemistry test turnaround time(TAT) in clinical laboratories.Methods Based on the approaches of standardized operations,5S on-site management,the efficiency evaluation of batch processing and one piece flow,and visual management,the median time of each workflow,the qualified rate of emergency biochemistry test TAT,the unqualified rate in a relatively concentrated period of TAT timeout and the unqualified rate of collected samples were compared before and after optimization.Results The median times (interquartile ranges) of each workflow including sample receipt and storage,result audit and sample storage-result report before and after lean management were 30 (35) min,7 (13) min,17 (8) min and 16(19) min,5(9) min,16(7) min,respectively,and there were significant differences in the former two(all P ＜0.01) but not the third (P ＞ 0.05).The median times (interquartile ranges) of TAT before and after lean management were 63 (51) min and 46 (33) min,respectively(P ＜ 0.05).The qualified rate of TAT increased from 86.00％ to 95.37％ after lean management(P ＜ 0.01).The unqualified rates in a relatively concentrated period of TAT timeout and collected samples decreased from 3.42％ to 1.00％ (P ＜0.01) and from 0.24％ to 0.17％ (P ＜ 0.01),respectively.Conclusion Lean management may improve process efficiency,reduce errors,and shorten emergency biochemistry test TAT in clinical laboratories.

Analysis of the turnaround time for biochemistry a ChongQing' hospital / 重庆医学

Objective To observe the turnaround time(TAT) of biochemistry laboratory in a certain hospital of Chongqing city,and to improve the quality of the laboratory by shortening the TAT.Methods TAT was analyzed by analyzing the daily workload,average TAT and failure rate of outpatient clinics,outpatient emergency,inpatient clinics,and inpatient emergency subjects from 2013 to 2015.The reasons for TAT prolongation were analyzed.Results The biochemical test samples were 77 060,97 129 and 105 304 from 2013 to 2015,and the annual growth rate was 26.0％ and 8.4％ respectively.TAT of the routine outpatient department samples were (78.55nu48.47)、(69.18± 37.20)、(62.82 ±21.62)min,which decreased year by year,and the difference were statistically significant(P＜0.05),and the TAT of the outpatient emergency were (64.13 ± 31.16),(59.22 ± 23.51),(66.01±37.73)min.TAT of inpatient clinics were (92.34± 53.41),(95.03±55.73) and (122.92±78.94)min from 2013 to 2015,which increased year by year,and the difference were statistically significant(P＜0.05),and the TAT of the inpatient emergency were(65.29±36.06),(62.41±30.18),(61.48±30.12)min,which decreased year by year,and the difference were statistically significant (P＜0.05).The substandard rate of samples aforementioned were 0.04％,2.99％,0.63％ and 3.69％,respectively.Conclusion TAT increases with the samples increase,it is necessary that making sure staffs more responsible in daily work,optimizing the procedure of daily biochemistry tests,improving ability of serving for clinic and patients.

Analysis of influencing factors of intra-laboratory turnaround time in emergency biochemistry tests / 国际检验医学杂志

Objective To investigate the intra-laboratory turnaround time(ILTAT) of the emergency biochemistry tests and to analyze the factors influencing ILTAT in order to adopt the corresponding improvement measures for perfecting the service quality and ensuring the patient medical safety.Methods ILTAT of the emergency biochemical specimens in our hospital from June to November 2015 was performed the retrospective statistics for comparing the determination timely rate between ILTAT≤60 min and ILTAT2 ≤120 min.ILTAT at different time periods in laboratory was emphatically analyzed.Results The determination timely rate of ILTAT ≤120min(ILTAT 1) was 98.8%(8638/8743),and which of ILTAT ≤60min(ILTAT 2) was 83.7%(7317/8743).The determination timely rate of ILTAT1 had no statistical difference among different time periods (χ2=3.36,P>0.05).The determination timely rate of ILTAT2 had statistical difference among different time periods(χ2=134.5,P<0.01).The determination timely rate of T 2(10:01-12:00) was highest (88.1%),which of T1 (8:01-10:00) was lowest(76.8%),which of T3(12:01-14:00) and T7 (6:01-8:00) was lower (79.4% and 80.2% respectively).Conclusion At present,ILTAT in our laboratory meets the requirements of the current regulations.Analyzing the ILTAT influencing factors in the emergency biochemistry,optimizing the workflow,improving the equipments and staffing allocation and improving the degree of information processing can further shorten the emergency biochemical ILTAT,and better meet the clinical and patient′s needs.

Changing Guidelines for Clinical Microbiology Laboratories and Their Influences on Workflows Related to Consultations

BACKGROUND: Since the concept of 'minimal identification of poor quality specimens or microbes with low pathogen potential' has been introduced into the standard operating procedure (SOP) to enhance work efficiency, consultations are requested for further species identification and antimicrobial susceptibility testing. The aim of this study was to evaluate the impact of consultations requests to the clinical microbiology laboratory on its work efficiency. METHODS: From January 2013 to April 2015, consultation requests to the laboratory in a tertiary-care hospital were collected from electronic medical records. The characteristics of consultations and changes to workflow due to the laboratory SOP amendment were analyzed. Turnaround time of the consultation and specimen culture were evaluated as an indicator of workflow efficiency. RESULTS: A total of 971 consultations were evaluated during the study period. The most common purposes for consultations were microbe species identification and antimicrobial susceptibility tests. Among the minimal identification reports, the proportions of consultations were below 5%. The number of consultations had increased substantially. However, the turnaround time of consultation and specimen culture showed declining trends. CONCLUSIONS: With the introduction of the consultation system, the workload for species identification and antimicrobial susceptibility testing of colonizing microbes could be minimized. This research provides an example of work efficiency management for laboratory procedures based on an SOP amendment.

Efficiency of an Automated Reception and Turnaround Time Management System for the Phlebotomy Room

BACKGROUND: Recent advances in laboratory information systems have largely been focused on automation. However, the phlebotomy services have not been completely automated. To address this issue, we introduced an automated reception and turnaround time (TAT) management system, for the first time in Korea, whereby the patient's information is transmitted directly to the actual phlebotomy site and the TAT for each phlebotomy step can be monitored at a glance. METHODS: The GNT5 system (Energium Co., Ltd., Korea) was installed in June 2013. The automated reception and TAT management system has been in operation since February 2014. Integration of the automated reception machine with the GNT5 allowed for direct transmission of laboratory order information to the GNT5 without involving any manual reception step. We used the mean TAT from reception to actual phlebotomy as the parameter for evaluating the efficiency of our system. RESULTS: Mean TAT decreased from 5:45 min to 2:42 min after operationalization of the system. The mean number of patients in queue decreased from 2.9 to 1.0. Further, the number of cases taking more than five minutes from reception to phlebotomy, defined as the defect rate, decreased from 20.1% to 9.7%. CONCLUSIONS: The use of automated reception and TAT management system was associated with a decrease of overall TAT and an improved workflow at the phlebotomy room.

Performance Evaluation of Automated Chemistry Analyser for Urine Chemistry Test

BACKGROUND: Prompt and accurate urine chemistry analysis is important to provide information for diagnosis and therapy. In this study, we evaluated the overall performance and utility of an automated chemistry analyser for urine chemistry testing in accordance with Clinical and Laboratory Standards Institute guidelines. METHODS: From January 2015 to March 2015, we evaluated the precision, linearity, limits of detection, carryover, and turnaround times after automation of nine items: total protein, albumin, glucose, blood urea nitrogen, total calcium, magnesium, inorganic phosphate, creatinine, and uric acid. A Hitachi 7600-110 instrument (Hitachi Ltd., Japan) and Hitachi ID Privileged Access Manager (Hitachi Ltd.) were used for automated chemistry analysis and sample preparation, respectively. RESULTS: Regarding precision, the coefficient of variation was 3.9% to 1.6% for high levels and 3.3% to 24.1% for low levels. The linearity and coefficients of determination of all the test items were acceptable. Performance comparison revealed that the two systems were comparable, as evidenced by correlation coefficients >0.975 for most items; moreover, carryover of all items was <1%. The mean turnaround time was 59 minutes. CONCLUSIONS: Urine chemistry testing can be performed with acceptable precision, linearity, and performance by using the Hitachi 7600-110 automated chemistry analyser. The sample preparation system reduces turnaround time, which enhances the clinical utility of urine chemistry testing.

Accuracy of frozen section analysis in correlation with surgical pathology diagnosis.

Background: Intra-operative consultation by frozen section is a high risk procedure with important consequences. Therefore it is critical to determine efficiency of frozen section performance periodically. This study was performed to determine accuracy of frozen section. Methods: In this prospective study, we compared the results of 100 consecutive cases of frozen section with their final permanent section diagnosis in a teaching hospital of Jawaharlal Nehru Medical College, Wardha, Maharashtra during July 2012 to June 2014. Results: A total of 100 cases were studied on frozen section while one case was deferred for permanent paraffin section (deferral rate 01%). The overall accuracy of frozen section was 96.96% with false positive and false negative rates of 1.01% and 2.02% respectively. Sensitivity, specificity, positive predictive value and negative predictive value were 97.22%, 96.30%, 98.59% and 92.86% respectively. The turn-around time of 18 minutes was observed in the present study. Conclusions: The accuracy of frozen section diagnosis at our institute can be interpreted as comparable with most international quality control statistics for frozen sections. The overall error rate and deferral rates are within the range previously published studies. The results suggest specific measures should be taken to reduce the number of discrepancies.

An Audit Of The Turnaround Time Of Fixed Prosthodontics Cases In The Ceramic Laboratory

This clinical audit is aimed to provide an insight into the performance of dental technicians in renderingfixed prosthodontics services at Faculty of Dentistry, University of Malaya. A retrospective audit wascarried out between 1st of November 2014 and 31st January 2015 using data derived from records andmonthly returns of the technicians, which are kept at the ceramic laboratory. Retrospective data oncases of diagnostic wax-ups, full metal crowns, metal ceramic crowns, all ceramic crowns and bridgesthat were sent to ceramic laboratory for fabrication from 1st of September 2013 to 31st of August 2014was systematically extracted from the record and tabulated categorically in SPSS version 22.0. Theturnaround time in workings day for diagnostic wax-ups and the prostheses was calculated by deductingexit date from entry date. Subsequently, the turnaround time and the complexity of cases were categorizedaccordingly. The association of turnaround time and the complexity of the cases was analysed usingFisher Exact test with p value < 0.05. Within this time frame, a total of 102 cases of diagnostic waxups,36 cases of crown and 18 cases of bridges were fabricated. 57.8% of diagnostic wax-ups werecompleted within 3 days. 100% of 1 unit crown were completed within 7 days and 94.4% of bridges werecompleted within 14 days. There was a significant association of turnaround time and the complexity ofthe cases for diagnostic wax-ups and crowns with p value <0.05. The standard for turnaround time isbeing met by the ceramic laboratory at Faculty of Dentistry, University of Malaya. However, due to theexcessive workload, the overall output of all the measured procedures remains low.

Study of determination of laboratory turnaround time in tertiary care hospital in India.

Turnaround time (TAT) is commonly defined as the time from when a test is ordered until the result is reported. TAT is often considered the most significant measure of a laboratory’s service and is used by many clinicians to judge its quality. Timely reporting of laboratory test results is now considered an important aspect of the services provided by the clinical laboratory. It has also been shown that outcomes in certain situations such as operation theaters and in emergency departments have been affected by timely reporting of lab tests results. Rapid laboratory turnaround times are important both from a medical and commercial point of view. The study was conducted from 1 April 2013 to 31 May 2013. Out of total 232 samples, 183 samples (78.88%) were taken for analysis. 100 (54.65%) samples were within TAT time and 83 (45.35 %) samples were delayed. Out of total 83 samples which were delayed, 48 (57.83%) samples had TAT between 60 minutes to 90 minutes, 22 (26.51%) samples had TAT between 90 minutes to 120 minutes, 9 (10.84%) samples had TAT between 120 minutes to 180 minutes, and 4 (4.82%) samples had TAT over 180 minutes. Average time between sample collection and lab reach was observed to be 15 min. 38 sec. Transport delay was observed. Instrumentation failure was observed in biochemistry - 2 times and thyroid - 1 time. Hence this study aims to evaluate the delay and reason of delay of turnaround time (TAT) of stat tests in section of clinical chemistry of the clinical laboratory.