A STUDY ON LABORATORY TURN AROUND TIME (TAT) IN EMERGENCY DEPARTMENT

INTRODUCTION: However, timeless which is expressed as the turnaround time (TAT) is often used by the clinicians as the benchmark for laboratory performance. Clinicians depend on fast TATs to achieve early diagnosis and treatment of their patients and to achieve early patient discharge from emergency departments or hospital in-patient services. Laboratory turnaround time is a reliable indicator of laboratory effectiveness. This study mainly aimed at calculating the minimum and maximum time taken for the advised investigations in emergency department.

DEFINITION: Laboratory turnaround time (TAT) is basically calculated from the time of clinicians advice to the time of report dispatch. This TAT is again divided into three phases as follows. Analytical phase: Time taken from clinicians advice to the sample placed in the analyzing machine. Pre-analytical phase: Time taken by the machine for processing the procedure. Post-analytical phase: From the time of procedure completion to report dispatch. AIM&OBJECTIVE: To study the TAT for biochemical samples in emergency department. MATERIAL & METHODS: It is a 1000 bedded hospital serving about 600 OP and 30 IP daily on an average. The study was conducted on 10 in-patients over a period of 24hours from 9 th Sep 2012 8:00 pm to 10th Sep 2012 8:00pm and the minimum &

maximum time calculated for the set of investigations advised by the clinician. Inpatient phlebotomies are performed by clinical department staff. The samples are delivered to the lab by the paramedical staff from the emergency department. Here the nursing staff performing the phlebotomy itself makes entry regarding the patient details and the nature of investigations advised. The lab staff recruited for sample receipt makes entry regarding the time of sample reception in the laboratory. RESULT: The following table-2 shows the turnaround times for a set of advised investigations in a 24 hour period for 10 inpatients. It has been found that the minimum time taken for the dispatch of required investigations was 90 minutes and the maximum of was 240 minutes. Because of the use of auto analyzers in the laboratories now a day the turnaround time for complete blood picture was found to be 5 minutes and for the electrolyte samples is approximately 30 minutes. It has also been observed that liver function test took a maximum of 1 hour. The time taken for individual parameters could not be calculated as the same was not followed in the laboratory .The TAT for stat samples as in case of surgeries etc. was found to be 1 hour as the samples are run on stat mode and the reports are collected either by the duty internee or by the patient attendants. The min. & max. Time taken for pre and post analytical phase are as follows. Table-1 Pre-analytical Minimum Maximum 15 min 30 min Postanalytical 60 min 240 min

It is quite evident from the table that the delays caused in TAT are primarily due to the post-analytical phase. The biggest impediment for prompt TAT in our setting is the lack of automated facilities for sample transport and report dispatch. We are still dependant on manual courier for sample transport and dispatch. The maximum time taken for the analysis of various common investigations advised in the emergency department has been tabulated below in table-3 INVESTIGATION CBP ESR MP WIDAL CUE RFT SR.ELECTROLYTE S LFT TIME 1 MIN 1 HOUR 10 MIN 15 MIN 45 MIN 1 HOUR 30 MIN 1 HOUR Table-3 DISCUSSION& RESULTS. : The clinicians are dependent on laboratory services for the initiation and evaluation of treatment

modalities. It is hence our prerogative to ensure timeliness. It is evident from the results that there is a lot of scope for the improvement of turnaround time in our setting particularly in the post analytical phase. We understand that the pre and post analytical phase are equally important for the laboratories more so where TAT is concerned. The total testing cycle describes TAT in a sequence of 8 steps like advise, collection & identification, transport, preparation, analysis, reporting, interpretation, and action. The term therapeutic TAT describes the interval when a test is requested to the time some therapeutic decision is taken. Our study demonstrates that the average TAT for the emergency samples is being maintained at 1 hr. The analytical and the pre- and post- analytical phase are equally important towards the TAT in this case. On the contrary it has been found that the reporting of the stable in patients as well as the patients attending OPD services is taking a minimum of 6-7 hrs. It is also observed that the exact time for the analytical phase of a particular sample is also not calculated in the lab. If this is calculated, the post analytical phase can be reasonably reduced with the responsibility of ensuring speedier reporting. One means of minimizing pre-analytical delays are adoption of ideal phlebotomy practices, bar coding of samples and computer generated requisition slips. The analytical phase can be streamlined by complete automation of laboratories, adoption of efficient quality control procedures, automatic dilutions in case of results exceeding linearity, prompt validation of reports etc. Ensure effective division of labor among the technicians so that sample processing and reporting occurs smoothly. The staff should be trained to handle urgent samples with utmost care and expedite their processing. The post analytical phase can be dramatically improved with the adoption of laboratory information services. This will abolish transcriptional

errors and delays caused in report dispatch. There is also a pertinent need to device transparent and effective communication between the clinician and laboratory technicians.