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Root cause analysis of laboratory turnaround times for patients in the emergency department

Published online by Cambridge University Press:  21 May 2015

Christopher M.B. Fernandes ,
Andrew Worster ,
Stephen Hill ,
Catherine McCallum  and
Kevin Eva
Christopher M.B. Fernandes*
Affiliation:
Emergency Medicine, Hamilton Health Sciences and McMaster University, Hamilton, Ont
Andrew Worster
Affiliation:
Emergency Medicine, Hamilton Health Sciences and McMaster University, Hamilton, Ont Department of Clinical Epidemiology And Biostatistics, McMaster University
Stephen Hill
Affiliation:
Hamilton Regional Laboratory Medicine Program, Hamilton, Ont Department of Pathology and Molecular Medicine, McMaster University
Catherine McCallum
Affiliation:
Hamilton Regional Laboratory Medicine Program, Hamilton, Ont
Kevin Eva
Affiliation:
Department of Clinical Epidemiology And Biostatistics, McMaster University
*
Emergency Medicine, Hamilton Health Sciences/McMaster University, 237 Barton St. E, Hamilton ON L8L 2X2; fax 905 528–0512, [email protected]

Abstract

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Introduction:

Laboratory investigations are essential to patient care and are conducted routinely in emergency departments (EDs). This study reports the turnaround times at an academic, tertiary care ED, using root cause analysis to identify potential areas of improvement. Our objectives were to compare the laboratory turnaround times with established benchmarks and identify root causes for delays.

Methods:

Turnaround and process event times for a consecutive sample of hemoglobin and potassium measurements were recorded during an 8-day study period using synchronized time stamps. A log transformation (ln [minutes + 1]) was performed to normalize the time data, which were then compared with established benchmarks using one-sample t tests.

Results:

The turnaround time for hemoglobin was significantly less than the established benchmark (n = 140, t = –5.69, p < 0.001) and that of potassium was significantly greater (n = 121, t = 12.65, p < 0.001). The hemolysis rate was 5.8%, with 0.017% of samples needing recollection. Causes of delays included order-processing time, a high proportion (43%) of tests performed on patients who had been admitted but were still in the ED waiting for a bed, and excessive laboratory process times for potassium.

Conclusions:

The turnaround time for hemoglobin (18 min) met the established benchmark, but that for potassium (49 min) did not. Root causes for delay were order-processing time, excessive queue and instrument times for potassium and volume of tests for admitted patients. Further study of these identified causes of delays is required to see whether laboratory TATs can be reduced.

Keywords

laboratoryturnaround timesquality improvementroot cause analysis
Type
ED Administration • L’administration de la MU
Information
Canadian Journal of Emergency Medicine , Volume 6 , Issue 2 , March 2004 , pp. 116 - 122
Copyright
Copyright © Canadian Association of Emergency Physicians 2004

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