Holland Lorne L, Smith Linda L, Blick Kenneth E
Department of Pathology, University of Oklahoma Health Sciences Center and OU Medical Center, Oklahoma City, OK 73190, USA.
Am J Clin Pathol. 2006 May;125(5):765-70. doi: 10.1309/3J5P-9VJR-UP4U-5RU5.
We obtained data on laboratory turnaround time (TAT) and emergency department (ED) length of stay (LOS). We correlated potassium test TAT outlier percentage (TAT-OP) with ED LOS and found that for each outlier percentage (potassium result > 40 minutes), a projected impact on ED LOS was approximately 2.8 additional minutes (ED LOS = 2.79 TAT-OP + 78.77). To address this issue, we began implementation of a totally automated chemistry system to decrease TAT-OPs. Our TAT means did not change substantially with automation (potassium, 28 to 27 minutes); however, TAT-OPs decreased substantially (potassium, 18% to 5%). Preautomation average ED LOS correlated best with the TAT-OP (r(2) = 0.98; P = .01), but this relationship weakened substantially after automation (r(2) = 0.29; P > .05), suggesting the laboratory was no longer a factor in ED LOS. The postautomation ED LOS correlated best with ED patient volume (r(2) = 0.88; P = .06). Although laboratories have focused on TAT means for performance assessment, our study suggests TAT-OPs are more clinically relevant benchmarks. Furthermore, our findings suggest that total laboratory automation can effectively improve overall laboratory service reliability and help eliminate the laboratory as a factor in ED LOS.
我们获取了实验室周转时间（TAT）和急诊科（ED）住院时间（LOS）的数据。我们将血钾检测TAT异常值百分比（TAT - OP）与ED LOS进行关联，发现每增加一个异常值百分比（血钾结果>40分钟），预计对ED LOS的影响约增加2.8分钟（ED LOS = 2.79 TAT - OP + 78.77）。为解决此问题，我们开始实施全自动化化学系统以降低TAT - OP。自动化后我们的TAT均值变化不大（血钾，从28分钟降至27分钟）；然而，TAT - OP大幅下降（血钾，从18%降至5%）。自动化前平均ED LOS与TAT - OP的相关性最佳（r(2) = 0.98；P = 0.01），但自动化后这种关系大幅减弱（r(2) = 0.29；P > 0.05），这表明实验室不再是影响ED LOS的因素。自动化后ED LOS与ED患者数量的相关性最佳（r(2) = 0.88；P = 0.06）。尽管实验室一直将TAT均值作为性能评估指标，但我们的研究表明TAT - OP是更具临床相关性的基准。此外，我们的研究结果表明，实验室全自动化可有效提高整体实验室服务可靠性，并有助于消除实验室作为影响ED LOS的一个因素。
