Clinical laboratory professionals at the Medical College of Georgia at Augusta University (AU) used automation, autoverification, point-of-care (POC) testing, and other strategies to achieve in-lab turnaround time (TAT) of 45 minutes for more than 90% of specimens orderable as STAT, effectively eliminating STAT testing except for “rare exceptions.” Results of this study appeared in Laboratory Medicine.
The international standard for STAT TAT time is <60 minutes for 90% of specimens. Some legitimate reasons exist for ordering a STAT test, such as to measure troponin in patients presenting to the emergency department (ED) with chest pain or hemoglobin in patients with excessive bleeding. But they pose some limitations and, as the authors emphasize, can disrupt a laboratory’s workflow. According to Gurmukh Singh, MD, PhD, vice chair of pathology at AU, STAT tests lose their efficiency once STAT test volume exceeds 30% of total test requests, overpowering staff and equipment capacity, and lengthening TAT for all tests. However, if the TAT for all tests is reduced to <45 minutes, “there is no need for anybody to order STAT,” said Singh in a statement. “Even if you are coming to see your doctor in the outpatient clinic, if we get the blood fast enough, we can get results back to your doctor even as he or she is talking with you.” AU had a history of a high volume of STAT tests, reaching 75% of all tests, according to the statement from AU.
“One way of dealing with this is to shorten TAT on all of your tests, so that no one had to order anything STAT,” Singh explained to CLN Stat. Singh and his team sought to accomplish this by dispensing with multiple queues and batch testing, standardizing procedures, and breaking processes down into individual steps—methods often used by successful automotive manufacturers.
They implemented the following measures:
- Installed universal front-end automation for routine chemistry and hematology tests in the core lab;
- Did on-site testing for selected analytes, in the ED, intensive care units, and operating rooms;
- Installed large in-lab monitors that displayed pending test results;
- Autoverified results into electronic medical records; and
- Expanded the pneumatic tube system to reach the facility’s core lab in a new location, and installed hardware and software updates to the system to improve reliability.
- Stepped up POC testing at the bedside in certain areas of the hospital, including the intensive care unit, the ED, and family medicine clinic.
- Quick staff huddles during shift changes to self-report on specimens not processed in a timely manner or missed critical result notifications, or to report on other issues such as instrument malfunctions.
With the amped up POC testing, “we could do tests right then and there, saving the time it takes to deliver the specimen from the patient to the core lab,” Singh told CLN Stat. While it would be ideal to do this with all patients, he acknowledged that it wouldn’t be that practical, given that POC tests cost more and aren’t as accurate as tests processed in the core lab.
STAT tests included panels such as complete blood count (CBC), coagulation tests, basic metabolic panel (BMP), comprehensive metabolic panel (CMP), renal panel, urine drug screen, and other tests such as alcohol, ammonia, lactate, magnesium, phosphate, troponin, and uric acid levels.
Through these efforts, Singh and his colleagues were able to reduce in-laboratory TAT to 45 minutes for more than 90% of tests orderable through STAT. For 93% of CBCs and CMPs, they achieved in-lab TAT of <45 minutes. “With the change in methods, the core laboratory now functions with about 20% fewer technical personnel members” and has improved its efficiency by using a single queue for all tests, the team reported. The authors noted that they did not implement a reduction in force but reduced the headcount by eliminating long-unfilled positions.
AU Health’s core lab has made its own improvements since the study, replacing manual with automated functions that have reduced TAT on samples. In future research, Singh’s team plans to look at reducing TAT for all infectious disease testing although there may be some biological limits to attempting this when culturing organisms is necessary, he indicated.