Delivering quicker reports for laboratory tests ordered in emergency departments

Prolonged turnaround time (TAT) of STAT emergency samples is the single most common cause of complaints about laboratory services all over the world. While the clinicians understandably desire quicker results for quicker clinical decisions affecting clinical outcomes, course and cost of treatment of these very sick patients; pathologists are frustrated by the unrealistic expectations of clinicians, excessive load of unnecessary STAT orders and delays outside laboratories affecting their TAT. This study was planned to find ways to improve TAT of emergency samples with the aim of quicker diagnosis, shorter stay in emergency, improved efficiencies of Emergency department (ED) and Laboratory (Lab), reducing hospital costs and improving patient experience. It was found that causes for delays most often lay outside lab. The remedy lay in correcting certain practices such as leaving drawn samples on bedside before transportation, drawing samples long after logging in Hospital information system, snags in Pnuematic tube system and delayed answering of lab calls in ED informing about critical results. Unnecessary ordering of tests as STAT increased the work load in lab. Other unexpected reasons for prolonged TAT were: non-cancellation of orders for rejected samples but waiting for arrival of a redrawn sample; and placing of future STAT orders for patients admitted from Emergency department. While the former resulted in prolonged Lab time, the latter resulted in prolonged Sample draw time and transport time as the hospital uses Pneumatic tube system for ED samples, but courier system for wards samples.