Physician satisfaction and emergency department laboratory test turnaroundtime - Observations based on College of American Pathologists Q-Probes studies

Objectives.-To determine the length of time for the components of the emerg ency department (ED) turn-around time (TAT) study in 1998 and to ascertain physician satisfaction concerning laboratory services to the ED. Methods.-Using forms supplied by the College of American Pathologists Q-Pro bes program, participants conducted a self-directed study of ED TAT over a 4-week period. Data requested included various times of day associated with the ordering, specimen collection, laboratory receipt, and result-reportin g stages of stat ED TATs for potassium and hemoglobin. Additionally, practi ce-related questions associated with the laboratory were asked. Participati ng laboratories also provided a physician satisfaction survey for up to 4 p hysicians who were users of: ED services. Results of both the TAT study and the physician satisfaction survey were returned by mail. Participants were drawn from the 952 hospital laboratories enrolled in the 1998 College of A merican Pathologists Q-Probes study on ED TAT. The main outcome measures in cluded the components of the ED TAT process, factors associated with decrea ses in ED TAT, and the results of the physician satisfaction survey. Results.-Six hundred ninety hospital laboratories (72.4% response rate) ret urned data on up to 18 230 hemoglobin and 18 259 potassium specimens. Half of these laboratories responded that 90% of potassium tests were ordered an d reported in 69 minutes or less, whereas the TAT for 90% of hemoglobin res ults was 55 minutes or less. Comparison of the components of TAT for both p otassium and hemoglobin with similar studies done in 1990 and 1993 showed n o change. Factors found to statistically contribute to faster TATs for both tests were laboratory control of specimen handling and rapid transport tim e. When whole blood specimens were used for potassium determination, TAT im proved. Emergency department physicians chose the study-defined lower satis faction categories of Often, Sometimes, Rarely, and Never for the questions concerning the laboratory being sensitive to stat testing needs (39.1%) an d meeting physician needs (47.6%). Many of the physicians surveyed believed that laboratory TAT caused delayed ED treatment more than 50% of the time (42.9%) and increased ED length of stay more than 50% of the time (61.4%) w hen compared with other specialty users of the ED. Conclusions.-Laboratory ED TATs have remained unchanged for almost a decade . Emergency department physicians are not satisfied with laboratory service s. Although it appears that one issue may relate to the other, the interact ion between the laboratory and the ED is quite complex and has been evolvin g for at least 30 years. Improvement in interoperability between the depart ments is essential for operational efficiency and patient care. Effective c ommunication channels need to be established to achieve these goals.