When it comes to clinical care-related decision making, perhaps no other information is as objective and important as laboratory test data. According to a 2019 study in the Journal of Applied Laboratory Medicine [1], virtually all inpatients and more than half of emergency department patients have one more or lab tests ordered for them, providing a vital source of objective data.

The lasting repercussions of poor processes

Efficient and accurate testing is of the utmost importance, particularly when diagnoses and treatment decisions hinge upon on lab data. Poor-quality testing – that which does not use sufficiently validated methods – leads to inadequate reproducibility, a narrow range of measurement and low analytical specificity.

The immediate effects are often time-consuming: samples may need to be re-tested for internal quality control and after dilution, and haemolysis may necessitate repeat blood sampling, both inconveniencing the patient and incurring re-testing costs for a hospital or healthcare system.

Poor processes can also have lasting broader repercussions that result in adverse patient outcomes. Inaccurate test results or delays in receiving them may cause a patient to experience unnecessary or insufficient treatment, treatment complications, or a lag in receiving the correct diagnosis.

So how can labs improve their operational efficiency to avoid such adverse outcomes? The solution is simple: adopt regimented processes, use high-quality reagents and devices, and get into the daily habit of adhering to ISO15189 plan–do–check–act (PDCA) practices.

A method our laboratory at the Hamamatsu University School of Medicine has found particularly useful for improving effectiveness is to assess and reduce testing turnaround time (TAT).

Sharing best practices to improve lab efficiency

Patients are rarely excited to undergo blood sampling. To improve the patient experience, it’s crucial that labs reduce the time between testing and the results becoming available, which involves shortening the time taken for each step of processing while maintaining high accuracy rates. And needless to say, it is important to establish and use a system free from both safety issues and the risk of testing errors.

Here are some practical approaches to help reduce TAT, based on lessons learned from our lab.

Firstly, a switch to automatically printed barcodes on test tubes does away with the need for phlebotomists to manually affix a patient label onto the tube. Mistaking a patient for the wrong person can be easily avoided by a visual verification of the label and bar code already on the test tube. This system allows the entire process of blood sampling to be completed within three to four minutes per patient, including the time taken for the changing of gloves.

Secondly, consider an automated carrier system, which carries a sample directly into analysers for simultaneous automated biochemical analysis and immunoanalysis. In our lab, these results are sent to the laboratory information system online, and the interim result to the hospital information system. The confirmed results are then dispatched following quality control and checks for outliers.

As a contingency against equipment failure, consider having a back-up analyser on standby for use to avoid major delays or unreliable results. Although this method means a lower processing capability, its strength is reliability. In our hospital, we have had very few complaints from clinical units with such a system in place. Occasionally, we see long TAT for certain samples, but these are generally special cases where the samples have fibrin precipitation or contain M-protein.

Finally, for quality control, audit the TAT in your lab regularly. In our laboratory we conduct biannual weeklong TAT investigations twice a year, each time for one week. Each test lasts a week because the manner by which samples are collected for a test varies from one day to another. This auditing enables us to identify points of weakness – where TAT is high – using a data-driven review of existing practice. The information gathered is also exchanged between the laboratory and hospital clinical units, so that the mean total TAT is publicly shared.

Cost-effective practice in the hospital setting

Successfully reducing TAT is a method that can help improve the cost-effectiveness of laboratory testing, thereby reducing contributions to total hospital expenditure.

The key, of course, is to balance efficiency and cost-effectiveness with the satisfaction of laboratory staff, physicians using the test results and, importantly, the patients. Although absolute spending may seem high, laboratory testing can be considered worth the investment if processing capability is high, TAT is low, performance is high, and the re-test rate is low. Ease of maintenance and minimising stress on laboratory technicians are also important factors that must be considered.  

As clinical medicine evolves, laboratories must implement practicable processes that minimise hospital spending while providing patients and physicians with accurate and time-efficient testing. Clinical laboratories should keep in mind:

• Poor lab processes can have lasting consequences on patient treatment and outcomes
• To reduce TAT while maintaining the high quality of testing samples, consider automating processes   
• Regular auditing and information-sharing improves efficiency and performance

[1] Ngo A., et al., 2017. Frequency that laboratory tests influence medical decisions. The Journal of Applied Laboratory Medicine, 1(4), pp.410-414.