Hospitals don’t need to construct a special satellite laboratory to achieve more timely delivery of chemotherapy to patients. A study in The Journal of Applied Laboratory Medicine describes how a team of researchers at a Chicago facility reduced turnaround time (TAT) of processing blood samples by improving workflow and reengineering preanalytical and analytical processes.
The influx of oncology patients seeking chemotherapy treatments in medical centers has increased wait times—a factor that patients strongly consider in assessing the quality of care they’re receiving from a facility. The University of Chicago Medical Center (UCMC) sees anywhere from 150 to 180 chemotherapy patient visits each day, with many patients seeking infusion treatments. Laboratory tests of patient specimens are crucial in deciding whether chemotherapy is a safe choice for patients. However, it’s often a major contributor of longer wait times in the clinic.
“Our clinic team observed a 2- to 3-hour average wait time for patients who need chemotherapy infusion,” the authors wrote.
A clinical team undertook the task of reducing TAT to less than 20 minutes for urgent complete blood count (CBC) and comprehensive metabolic panels (CMP)—two tests commonly ordered for chemotherapy patients. The idea of constructing a dedicated patient satellite lab nearby to reduce TAT was initially proposed but later discarded due to the extra time, effort, and costs associated with building, staffing, and stocking such a facility.
An alternative solution was to work within the existing system, leveraging lab informatics to collect TAT data for CBC and CMP for 1 month. “Based on the TAT data analysis, we delineated and reconfigured workflow strategies to reduce laboratory TAT of CBC and CMP panels ordered in chemotherapy clinics,” according to the investigators. Transporting CBC specimens directly to the hematology lab after collection and regarding all CMP samples from chemotherapy clinics as urgent helped achieve this goal.
Through these efforts, median CBC specimen collection to result release (Col-Res) TAT averaged just 16 minutes. For CMP, TAT decreased from 74 to 54 minutes. “Even under the best re-engineered workflow conditions, the CMP cannot be further reduced beyond 54 minutes as we’ve hit the limitation of the automated chemistry analytics,” senior author K.T. Jerry Yeo, PhD, a pathology professor and medical director of the clinical chemistry, clinical pharmacogenomics, and translational mass spectrometry laboratories at UChicago MedLabs, told CLN Stat.
The investigators consulted with UCMC’s lead oncologist, who advised that they include bilirubin and creatinine—two key chemistry tests for analyzing liver and renal toxicity. “We researched and found that the only way to deliver these two tests rapidly was to resort to using a whole blood analyzer like the ABL 800,” Yeo said. The ABL 800 saves time by negating the need for centrifuging and has short analytical times for both tests. Through this approach, the team was able to reduce TAT for total bilirubin and creatinine to 9 minutes.
Read the September issue of JALM to get the details on this TAT success story in Chicago.