Department of Emergency Medicine, Tehran University of Medical Sciences, Tehran, Iran.
Arch Iran Med. 2012 Dec;15(12):759-63.
Laboratory turnaround time (TAT) is an important determinant of patient stay and quality of care. Our objective is to evaluate laboratory TAT in our emergency department (ED) and to generate a simple model for identifying the primary causes for delay.
We measured TATs of hemoglobin, potassium, and prothrombin time tests requested in the ED of a tertiary-care, metropolitan hospital during a consecutive one-week period. The time of different steps (physician order, nurse registration, blood-draw, specimen dispatch from the ED, specimen arrival at the laboratory, and result availability) in the test turnaround process were recorded and the intervals between these steps (order processing, specimen collection, ED waiting, transit, and within-laboratory time) and total TAT were calculated. Median TATs for hemoglobin and potassium were compared with those of the 1990 Q-Probes Study (25 min for hemoglobin and 36 min for potassium) and its recommended goals (45 min for 90% of tests). Intervals were compared according to the proportion of TAT they comprised.
Median TATs (170 min for 132 hemoglobin tests, 225 min for 172 potassium tests, and 195.5 min for 128 prothrombin tests) were drastically longer than Q-Probes reported and recommended TATs. The longest intervals were ED waiting time and order processing.
Laboratory TAT varies among institutions, and data are sparse in developing countries. In our ED, actions to reduce ED waiting time and order processing are top priorities. We recommend utilization of this model by other institutions in settings with limited resources to identify their own priorities for reducing laboratory TAT.
实验室周转时间（TAT）是患者住院时间和医疗质量的重要决定因素。我们的目的是评估我们急诊科的实验室 TAT，并生成一个简单的模型来确定延迟的主要原因。
我们在一家三级城市医院的急诊科连续一周测量了血红蛋白、钾和凝血酶原时间测试的 TAT。记录了测试周转过程中不同步骤（医生医嘱、护士登记、采血、ED 标本发出、标本到达实验室和结果可用）的时间，并计算了这些步骤之间的间隔（医嘱处理、标本采集、ED 等待、转运和实验室内部时间）和总 TAT。血红蛋白和钾的中位数 TAT 与 1990 年 Q-Probes 研究（血红蛋白 25 分钟，钾 36 分钟）及其推荐目标（90%的测试 45 分钟）进行了比较。根据它们在 TAT 中所占的比例来比较间隔。
132 次血红蛋白测试的中位数 TAT（170 分钟）、172 次钾测试的中位数 TAT（225 分钟）和 128 次凝血酶原测试的中位数 TAT（195.5 分钟）明显长于 Q-Probes 报告和推荐的 TAT。最长的间隔是 ED 等待时间和医嘱处理。
实验室 TAT 在不同机构之间存在差异，在发展中国家数据稀缺。在我们的急诊科，减少 ED 等待时间和医嘱处理是当务之急。我们建议其他资源有限的机构利用这种模式来确定自己的实验室 TAT 降低优先级。
