Steindel Steven J, Jones Bruce A
Centers for Disease Control and Prevention, Public Health Practice Program Office, Division of Laboratory Systems, Laboratory Performance Assessment Branch, Chamblee, GA 30333, USA.
Arch Pathol Lab Med. 2002 Jan;126(1):11-8. doi: 10.5858/2002-126-0011-ROLTTT.
To determine baseline parameters for routine outpatient test turnaround time (TAT), to identify influential factors, and to study the impact of managed care on this testing.
Using forms supplied by the College of American Pathologists Q-Probes program, laboratories conducted a self-directed study of routine outpatient TATs over a 4-week period. Data requested included various times of day associated with the collection, laboratory receipt, and result verification of specimens, as well as details on the drawing location and ordering and delivery methods for up to 3 tests, namely, a complete blood cell count (CBC), biochemical profile, or thyrotropin test. For the CBC, an indication was requested if a manual differential was performed. Additionally, practice-related questions were asked, including several about whether the laboratory was associated with a managed care organization (MCO). The main outcome measures included the components of the TAT process and related factors.Participants.-Six hundred nineteen laboratories from those enrolled in the 1997 College of American Pathologists Q-Probes program.
Data were submitted by 614 participants, most US hospitals, and represented 30 240 CBCs, 25 683 biochemical profiles, and 14 801 thyrotropins. Collection to verification TATs increased for specimens received later in the day for all analytes, but the magnitude of the increase was greatest for thyrotropin. Collection to laboratory receipt TAT was similar for all analytes, but the time and distribution increased with time of day. Testing time (receipt to verification) was similar for the CBC and biochemical profile, but was greatly increased for thyrotropin. Most participants tested the CBC and the biochemical profile as they arrived, but many delayed testing for thyrotropin. Most (70%) outpatient specimens were collected within the institution; only about 10% came from local physicians' offices. A median 46.7% of hospital testing involved outpatients. Only 10% of laboratories operated under an MCO; these laboratories reported a median of 45% of specimens coming from their MCO. Being associated with an MCO increased TAT for the CBC and biochemical profile.
Outpatient testing comprises about half of all hospital testing, yet systems are not optimized. Preanalytic TAT increases during the day, which indicates increasing delays in the collection and transport stages. Imposition of a test schedule on thyrotropin results in a delay pattern that is very different from the CBC and biochemical profile, which are tested on arrival. A laboratory's association with an MCO had a weak impact on TAT.
确定常规门诊检查周转时间（TAT）的基线参数，识别影响因素，并研究管理式医疗对该项检查的影响。
各实验室使用美国病理学家学会Q-Probes项目提供的表格，在4周时间内对常规门诊TAT进行自主研究。所需数据包括与标本采集、实验室接收及结果核实相关的一天中的不同时间，以及多达三项检查（即全血细胞计数（CBC）、生化指标或促甲状腺激素检测）的采血地点、医嘱及送检方式的详细信息。对于CBC检查，若进行手工分类计数则需提供相关说明。此外，还询问了与实践相关的问题，包括几个关于实验室是否与管理式医疗组织（MCO）相关的问题。主要观察指标包括TAT过程的组成部分及相关因素。参与者——来自1997年美国病理学家学会Q-Probes项目登记的619家实验室。
614名参与者提交了数据，其中大多数是美国医院，数据涵盖30240份CBC检查、25683份生化指标检查和14801份促甲状腺激素检测。对于所有分析物，当天晚些时候接收的标本从采集到核实的TAT均增加，但促甲状腺激素的增加幅度最大。所有分析物从采集到实验室接收的TAT相似，但时间及分布随一天中的时间增加。CBC检查和生化指标检查的检测时间（接收至核实）相似，但促甲状腺激素检测的时间大幅增加。大多数参与者在标本送达时就进行CBC检查和生化指标检查，但许多人会延迟促甲状腺激素检测。大多数（70%）门诊标本在机构内采集；只有约10%来自当地医生办公室。医院检测中门诊患者的比例中位数为46.7%。只有10%的实验室在MCO下运营；这些实验室报告称其标本中位数的45%来自其MCO。与MCO相关会增加CBC检查和生化指标检查的TAT。
门诊检查约占医院所有检查的一半，但系统未得到优化。分析前TAT在一天中会增加，这表明采集和运输阶段的延迟在增加。对促甲状腺激素检测设定检测时间表会导致与CBC检查和生化指标检查（送达即检测）非常不同延迟模式。实验室与MCO的关联对TAT的影响较弱。
