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TURN AROUND TIME OF LAB

DR. A.K. KHANDELWAL

Consultant Hospital Management

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WHAT IS TAT?

The laboratory's perception :TAT is from the

time the specimen is received to the analysisis completed.

Physicianss perception. : TAT is from the

order is written to the result is available

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IMPORTANCE

Efficiency of clinicians increased

Decreased Hospital stay

Increased customer satisfaction

Increased hospital business

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TAT Benchmarks

At present, TATs for most stat clinical laboratory

tests are less than 1 hour and 2 working days formost routine surgical pathology cases

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Time Required by Biochemistry Analyser

sample put to centrifuser for serum separation-------30-45min-------------/+Water bath----5min-----------serum put in

analyzer--------30min-------------/ another30 min if recheck-------Report is generated10min-------preliminary reportavailable.Total Time- 75 min to105 min

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Time Required for CBC by Cell Counter

Sample put in rotator for proper mixing---------10min---------sample put to machine-------3-4 min---report is generated--------preliminary report is available

Total time- 15 min.

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All laboratory tests can be divided into three

phases: preanalytic, analytic, and postanalytic.

Preanalytic-the time required to requisition,

collect, and transport specimens;

Analytic-the time required to prepare specimens

and perform the analysis;

Postanalytic-the time required to report results

back to the patient's physician

Three phases laboratory tests

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The literature has shown that the analytic phase of the

TAT is not commonly the area in need of improvement,

and the preanalytic and postanalytic phases are morefrequently to blame for a delayed result.

With modern instrumentation, analysis time comprises

only 1% to 3% of the TAT.

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Technology has allowed for the innovations necessary for

the improvement of the TAT.

Since a TAT has three phases, preanalytic, analytic, and

postanalytic, these technologies have been designed for

improvement at the particular phase of interest.

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It is usually the analytic phase with which the laboratory

personnel are more concerned, but, to analyze and improve

TATs, all three phases have to be examined because

deficiencies can occur at any level .

The deficient phase has to be targeted so the solution can be

presented.

How to improve TAT

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Pneumatic Tubing System,

Satellite Laboratory,

Point Of Care Testing(bed Side Testing)

Improved Computer Technology

Successful solutions for improving TAT

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A pneumatic tubing system consists of stations throughout

the hospital with a tube interconnecting them. Carriers

can be placed in the tubes to carry samples to a desired

destination.

Study revealed that pneumatic tubing system expedite

transport of specimens to the laboratory with time range

for specimen coming from different locations of 30 to 43

seconds.

Pneumatic Tubing System

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Computers have the capability of reducing TAT at all

phases.

Order can go directly from the department to the

laboratory.

Instruments can be interfaced so that results go directly

into the computer.

After results are reviewed by laboratory personnel, theyare then readily available to the ordering physician to

access via the computer

Computer Technology

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Laboratory information system (LIS) is a fundamental

building block in the development of a laboratoryautomation system (LAS).

Studies revealed that use of a computer has reduced

the TAT anywhere from 25% to 50%.

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Point-of-Care Testing

Point-of-care testing (POCT) is by definition a bedside

or near-bedside test.

POCT is aimed at reducing TAT at every phase.

The collection, analysis, and review of results are

performed within minutes at the location of the patient.

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Satellite laboratories exist outside of the central laboratory,

usually in areas of the hospital where rapid patient care is

essential.

Setting up a satellite laboratory can help reduce the preanalytic

portion of the TAT, but the postanalytic problems will still exist

But satellite laboratory has had mixed reviews and furtherstudies are needed to demonstrate effectiveness.

Satellite Laboratory

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Step -Test selection and order entry

Standardize nomenclature for easy lookup

Customize screens for rapid ordering

Enable providers to order electronically

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. Ensure accuracy of admission, discharge, transferdata updates (for patient location)

Consider patient location tracking

Automate lookup of information on volume,

container, and special precautions for obtaining andhandling specimens.

Step-Specimen collectionand delivery

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Element- ActionsPhlebotomy Scrutinize phlebotomy practicesSpecimen labeling Use bar codesSpecimen delivery pneumatic tubeSpecimen type Review use of plasma and serum separator

tubes and whole blood

Specimen arrival Use bar code readers

Specimen sorting Evaluate use of front-end automation: sorts,centrifuges, decaps, and prepares aliquots Sample directly fromspecimen container (as appropriate)

Step-Accessioning

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Step- Reporting

Adopt efficient quality control procedures

Interface instrumentation to computer

Generate preliminary reports

Transmit reports via computer, broadcast(electronic board),pager, and/or Internet.

Consider automatic printing for locations such as

intensive care units

Provide assistance with results and interpretation(help desk, interpretive reports,reflex testing

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Consider total laboratory automation

Ensure minimal downtime and adequacy of

backup. Use automatic repeats (for abnormal results)

and dilutions for results exceeding Linearity

Consider automatic verification of results

within reference limits

Steps- Testing

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The laboratory has to function to give patients the best

and fastest care possible.

Rapid TAT is important both from a medical andcommercial point of view.

In the era of cost consciousness , competion and Consumer

awareness hospitals cannot afford to have Slow TAT and

lose customers because of poor satisfaction with service.

Conclusion