Using outlier events to monitor test turnaround time - A College of American pathologists Q-Probes study in 496 laboratories

Objectives.-To determine the causes of excessive test turnaround time (TAT) and to identify methods of improvement by studying reasons for those tests reported in excess of 70 minutes from the time the test was ordered tie, o utliers). Design.-Self-directed data-gathering of stat outlier TAI events from intens ive care units and emergency departments, with descriptive parameters assoc iated with each event and additional descriptive parameters associated with the participant. Participants.-Laboratories enrolled in the 1996 College of American Patholo gists Q-Probes program. Main Outcome Measures.-Components associated with outlier TAT events and ou tlier TAT rates. Results.-Four hundred ninety-six hospital laboratories returned data on 218 551 stat tests, of which 10.6% had TATs in excess of 70 minutes. Ten perce nt of stat emergency department tests and 14.7% of stat intensive care unit tests were outliers. Major areas in which delays occurred were test orderi ng, 29.9%; within-laboratory (analytic) phase, 28.2%; collection of the spe cimen, 27.4%; postanalytic phase, 1.9%; and undetermined, 12.5%. The type o f test performed was a significant factor and was independent of location: Chemistry-Multiple Test appeared most frequently (similar to 40%), followed closely by Hematology-Complete Blood Count (similar to 20%) and Chemistry- Single Test (similar to 18%). Factors of outlier TAT components for intensi ve care unit specimens were identified using statistical modeling and inclu ded hour of day, type of health care personnel collecting specimen, perform ing the test in a stat laboratory, and reason for delay. Outlier rates were not associated with any identified factors. The practice parameters of lab oratories with outlier rates in the lowest 10th percentile significantly di ffered from those with rates in the top 10th percentile in test request com puterization, report methods, and ordering methods. Conclusions.-We observed that outlier analysis yields new information, such as type of test and reason for delay, concerning test delays when compared with TAT determination alone. Laboratories experiencing stat test TAT prob lems should use this tool as an adjunct to routine TAT monitoring for ident ifying unique causes of delay.