The simple fact is that laboratories can’t accommodate every STAT request. In the March Clinical Laboratory News, Stacy E.F. Melanson, MD, PhD, offers some strategies for tackling a frustrating problem that invariably causes friction between labs and clinicians and has a big impact on patient care. “Expectations and goals for STAT testing must be realistic,” writes Melanson, an associate director of clinical laboratories, co-director of chemistry, and medical director of phlebotomy at Brigham and Women’s Hospital in Boston.
Optimizing preanalytical inputs for STAT testing is one way to address this issue, she advises. Labs should define the percentage of STAT specimens they can handle effectively, then decide which tests or specimens among the thousands that arrive daily are, in fact, STAT. With a goal of collecting specimens within half an hour, Brigham and Women’s revised its rounding schedule to improve STAT testing processes, creating assignments and establishing priorities within those assignments.
Labs should also develop a strategy for triaging specimens when they arrive in laboratories. “At our institution, code specimens with their special bright orange requisitions are our first priority. Other priority areas have color-bordered specimen labels,” Melanson explains.
Address STAT requests case by case, Melanson suggests. “This typically involves multidisciplinary meetings analyzing current procedures, confirming clinical impact, and discussing realistic goals.” Labs need to ask themselves why results need urgent attention, what costs or resources are involved, how they measure success or failure, and how all of this affects patient care.
At Brigham and Women’s, the lab made some changes and exceptions to its STAT processes. “For a limited number of tests like troponin, we default the orders to STAT in our electronic health record. In some cases, we implemented point-of-care testing (POCT) because POCT arose as the best solution to barriers identified in our meetings, such as the need for intraoperative blood gas results,” Melanson writes.
Decompressing central laboratory test volume is another strategy that seeks to improve existing STAT testing and allows for additional requests.
Labs need to accept the fact that they won’t please all departments or achieve goals 100% of the time, Melanson emphasizes.
Pick up the March CLN to learn more about balancing STAT goals and reasonable expectations.