Coetzee Lindi-Marie, Cassim Naseem, Glencross Deborah K
National Health Laboratory Service (NHLS), Johannesburg, South Africa.
Department of Molecular Medicine and Haematology, University of the Witwatersrand, Johannesburg, South Africa.
Afr J Lab Med. 2020 Dec 21;9(1):1102. doi: 10.4102/ajlm.v9i1.1102. eCollection 2020.
High-level monthly, quarterly and annual turn-around time (TAT) reports are used to assess laboratory performance across the National Health Laboratory Service in South Africa. Individual laboratory performances are masked by aggregate TAT reporting across network of testing facilities.
This study investigated weekly TAT reporting to identify laboratory inefficiencies for intervention.
CD4 TAT data were extracted for 46 laboratories from the corporate data warehouse for the 2016/2017 financial period. The total TAT median, 75th percentile and percentage of samples meeting organisational TAT cut-off (90% within 40 hours) were calculated. Total TAT was reported at national, provincial and laboratory levels. Provincial TAT performance was classified as markedly or moderately poor, satisfactory and good based on the percentage of samples that met the cut-off. The pre-analytical, testing and result review TAT component times were calculated.
Median annual TAT was 18.8 h, 75th percentile was 25 h and percentage within cut-off was 92% ( = 3 332 599). Corresponding 75th percentiles of component TAT were 10 h (pre-analytical), 22 h testing and 1.6 h review. Provincial 75th percentile TAT varied from 17.6 h to 34.1 h, with three good ( = 13 laboratories), four satisfactory ( = 24 laboratories) and two poor performers ( = 9 laboratories) provinces. Weekly TAT analysis showed 12/46 laboratories (28.6%) without outlier weeks, 31/46 (73.8%) with 1-10 outlier weeks and 3/46 (6.5%) with more than 10 (highest of 20/52 weeks) outlier weeks.
Masked TAT under-performances were revealed by weekly TAT analyses, identifying poorly performing laboratories needing immediate intervention; TAT component analyses identified specific areas for improvement.
南非国家卫生实验室服务中心使用月度、季度和年度的高水平周转时间（TAT）报告来评估实验室绩效。整个检测设施网络的汇总TAT报告掩盖了各个实验室的绩效情况。
本研究调查每周的TAT报告，以识别实验室效率低下之处以便进行干预。
从公司数据仓库中提取了46个实验室在2016/2017财政年度的CD4 TAT数据。计算了总TAT中位数、第75百分位数以及达到机构TAT截止时间（40小时内90%）的样本百分比。在国家、省和实验室层面报告了总TAT。根据达到截止时间的样本百分比，将省级TAT绩效分为明显较差、中等较差、令人满意和良好。计算了分析前、检测和结果审核的TAT组成部分时间。
年度TAT中位数为18.8小时，第75百分位数为25小时，在截止时间内的百分比为92%（n = 3 332 599）。组成部分TAT的相应第75百分位数分别为10小时（分析前）、22小时（检测）和1.6小时（审核）。省级第75百分位数TAT从17.6小时到34.1小时不等，有三个表现良好的省份（n = 13个实验室）、四个表现令人满意的省份（n = 24个实验室）以及两个表现较差的省份（n = 9个实验室）。每周的TAT分析显示，46个实验室中有12个（28.6%）没有异常周，31个（73.8%）有1至10个异常周，3个（6.5%）有超过10个（最多20/52周）异常周。
每周的TAT分析揭示了被掩盖的TAT表现不佳情况，识别出需要立即干预的表现不佳的实验室；TAT组成部分分析确定了具体的改进领域。
