From the Department of Clinical Pathology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand (Trongnit, Reesukumal, Kost, Pratumvinit).
The Department of Pathology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand (Trongnit).
Arch Pathol Lab Med. 2023 Jan 1;147(1):87-93. doi: 10.5858/arpa.2021-0444-OA.
CONTEXT.—: Timely reperfusion improves the recovery of patients with acute ischemic stroke. Laboratory results are crucial to guide treatment decisions in patients when abnormal laboratory tests are suspected.
OBJECTIVE.—: To implement a new laboratory workflow for acute stroke patients and compare laboratory turnaround time (TAT) preimplementation and postimplementation.
DESIGN.—: We conducted a retrospective pre-post intervention study of patients with suspected acute stroke during the 4-month periods before and after the implementation of a new laboratory workflow process. The improvement process included relocating the specimen registration site, laboratory notification before specimen arrival, a color-coding system on tubes, timing at all processes, and eliminating the smear review if platelets were normal. TATs of the laboratory and door-to-clinical intervention times before and after the improvement process were compared.
RESULTS.—: Postintervention, median specimen transportation time decreased from 11 (interquartile range [IQR], 8.4-16.4) to 9 minutes (IQR, 6.3-12.8), P < .001. The intralaboratory and total TATs of complete blood cell count, coagulation tests, and creatinine significantly decreased (P < .001 for all). Blood drawn-to-laboratory reported time decreased from 43 (IQR, 36.0-51.5) to 33 minutes (IQR, 29.2-35.8, P < .001). However, door-to-needle time for thrombolysis and door-to-puncture time and door-to-recanalization time for mechanical thrombectomy were not statistically different (P = .11, .69, and .50, respectively).
CONCLUSIONS.—: The new laboratory workflow significantly decreased transportation time, TAT of individual tests, and the blood drawn-to-laboratory reported time. However, the time to treatment of acute ischemic stroke patients was not different between preimplementation and postimplementation.
及时再灌注可改善急性缺血性脑卒中患者的恢复情况。当怀疑实验室检查异常时，实验室结果对指导患者的治疗决策至关重要。
为急性脑卒中患者实施新的实验室工作流程，并比较实施前后的实验室周转时间（TAT）。
我们对实施新的实验室工作流程前后 4 个月疑似急性脑卒中患者进行了回顾性前后干预研究。改进过程包括将标本登记处迁移、标本到达前通知实验室、管上的彩色编码系统、所有过程的计时以及如果血小板正常则消除涂片检查。比较了改进前后实验室和从门到临床干预的 TAT。
干预后，标本运输时间中位数从 11 分钟（四分位距 [IQR]，8.4-16.4）降至 9 分钟（IQR，6.3-12.8），P <.001。全血细胞计数、凝血试验和肌酐的实验室和总 TAT 显著降低（P <.001 ）。采血至实验室报告时间从 43 分钟（IQR，36.0-51.5）降至 33 分钟（IQR，29.2-35.8，P <.001）。然而，溶栓的门到针时间以及机械血栓切除术的门到穿刺时间和门到再通时间无统计学差异（分别为 P =.11、.69 和.50）。
新的实验室工作流程显著缩短了运输时间、各测试的 TAT 以及采血至实验室报告时间。然而，实施前后急性缺血性脑卒中患者的治疗时间无差异。
