TAT Analysis

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A STUDY ON LABORATORY TURN AROUND TIME (TAT)

IN

EMERGENCY DEPARTMENT

INTRODUCTION: However, timeless which is expressed as the

turnaround time (TAT) is often used by the clinicians as the

benchmark for laboratory performance. Clinicians depend on fast

TATs to achieve early diagnosis and treatment of their patients

and to achieve early patient discharge from emergency

departments or hospital in-patient services. Laboratory

turnaround time is a reliable indicator of laboratory effectiveness.

This study mainly aimed at calculating the minimum and

maximum time taken for the advised investigations in emergency

department.

DEFINITION: Laboratory turnaround time (TAT) is basically

calculated from the time of clinicians advice to the time of report

dispatch. This TAT is again divided into three phases as follows.

Analytical phase: Time taken from cliniciansadvice to the sample placed in the analyzing machine.

Pre-analytical phase: Time taken by the machine

for processing the procedure.

Post-analytical phase: From the time of procedure

completion to report dispatch.

AIM&OBJECTIVE: To study the TAT for biochemical samples in

emergency department.

MATERIAL & METHODS: It is a 1000 bedded hospital serving

about 600 OP and 30 IP daily on an average. The study was

conducted on 10 in-patients over a period of 24hours from 9th Sep

2012 8:00 pm to 10th Sep 2012 8:00pm and the minimum &

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maximum time calculated for the set of investigations advised by

the clinician.

Inpatient phlebotomies are performed by clinical

department staff. The samples are delivered to the lab by theparamedical staff from the emergency department. Here the

nursing staff performing the phlebotomy itself makes entry

regarding the patient details and the nature of investigations

advised. The lab staff recruited for sample receipt makes entry

regarding the time of sample reception in the laboratory.

RESULT: The following table-2 shows the turnaround times for a

set of advised investigations in a 24 hour period for 10 inpatients.

It has been found that the minimum time taken for the dispatch ofrequired investigations was 90 minutes and the maximum of was

240 minutes. Because of the use of auto analyzers in the

laboratories now a day the turnaround time for complete blood

picture was found to be 5 minutes and for the electrolyte samples

is approximately 30 minutes. It has also been observed that liver

function test took a maximum of 1 hour. The time taken for

individual parameters could not be calculated as the same was

not followed in the laboratory .The TAT for stat samples as in caseof surgeries etc. was found to be 1 hour as the samples are run on

stat mode and the reports are collected either by the duty

internee or by the patient attendants.

The min. & max. Time taken for pre and post

analytical phase are as follows.

Table-1

Pre-analytical Post-

analytical

Minimum 15 min 60 min

Maximum 30 min 240 min

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It is quite evident from the table that the delays caused

in TAT are primarily due to the post-analytical phase.

The biggest impediment for prompt TAT in our setting is the

lack of automated facilities for sample transport and report

dispatch. We are still dependant on manual courier for sample

transport and dispatch. The maximum time taken for the analysis

of various common investigations advised in the emergency

department has been tabulated below in table-3

INVESTIGATION TIME

CBP 1 MIN

ESR 1

HOUR

MP 10 MIN

WIDAL 15 MIN

CUE 45 MIN

RFT 1

HOUR

SR.ELECTROLYTE

S

30 MIN

LFT 1

HOUR

Table-3

DISCUSSION& RESULTS. : The clinicians are dependent on

laboratory services for the initiation and evaluation of treatment

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modalities. It is hence our prerogative to ensure timeliness. It is

evident from the results that there is a lot of scope for the

improvement of turnaround time in our setting particularly in the

post analytical phase. We understand that the pre and post

analytical phase are equally important for the laboratories moreso where TAT is concerned.

The total testing cycle describes TAT in a sequence of

8 steps like advise, collection & identification, transport,

preparation, analysis, reporting, interpretation, and action. The

term therapeutic TAT describes the interval when a test is

requested to the time some therapeutic decision is taken.

Our study demonstrates that the average TAT for theemergency samples is being maintained at 1 hr. The analytical

and the pre- and post- analytical phase are equally important

towards the TAT in this case. On the contrary it has been found

that the reporting of the stable in patients as well as the patients

attending OPD services is taking a minimum of 6-7 hrs. It is also

observed that the exact time for the analytical phase of a

particular sample is also not calculated in the lab. If this is

calculated, the post analytical phase can be reasonably reducedwith the responsibility of ensuring speedier reporting.

One means of minimizing pre-analytical delays are

adoption of ideal phlebotomy practices, bar coding of samples

and computer generated requisition slips. The analytical phase

can be streamlined by complete automation of laboratories,

adoption of efficient quality control procedures, automatic

dilutions in case of results exceeding linearity, prompt validation

of reports etc. Ensure effective division of labor among thetechnicians so that sample processing and reporting occurs

smoothly. The staff should be trained to handle urgent samples

with utmost care and expedite their processing. The post

analytical phase can be dramatically improved with the adoption

of laboratory information services. This will abolish transcriptional

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errors and delays caused in report dispatch. There is also a

pertinent need to device transparent and effective

communication between the clinician and laboratory technicians.