Journal:Timely delivery of laboratory efficiency information, Part I: Developing an interactive turnaround time dashboard at a high-volume laboratory

Full article title	Timely delivery of laboratory efficiency information, Part I: Developing an interactive turnaround time dashboard at a high-volume laboratory
Journal	African Journal of Laboratory Medicine
Author(s)	Cassim, Naseem; Tepper, Manfred E.; Coetzee, Lindi M.; Glencross, Deborah K.
Author affiliation(s)	National Health Laboratory Service, University of the Witwatersrand
Primary contact	Email: naseem dor cassim at wits dot ac dot za
Year published	2020
Volume and issue	9(2)
Article #	a947
DOI	10.4102/ajlm.v9i2.947
ISSN	2225-2010
Distribution license	Creative Commons Attribution 4.0 International License
Website	https://ajlmonline.org/index.php/ajlm/article/view/947/1482
Download	https://ajlmonline.org/index.php/ajlm/article/download/947/1479 (PDF)

Abstract

Background: Mean turnaround time (TAT) reporting for testing laboratories in a national network is typically static and not immediately available for meaningful corrective action and does not allow for test-by-test or site-by-site interrogation of individual laboratory performance.

Objective: The aim of this study was to develop an easy-to-use, visual dashboard to report interactive graphical TAT data to provide a weekly snapshot of TAT efficiency.

Methods: An interactive dashboard was developed by staff from the National Priority Programme and Central Data Warehouse of the National Health Laboratory Service in Johannesburg, South Africa, during 2018. Steps required to develop the dashboard were summarized in a flowchart. To illustrate the dashboard, one week of data from a busy laboratory for a specific set of tests was analyzed using annual performance plan TAT cutoffs. Data were extracted and prepared to deliver an aggregate extract, with statistical measures provided, including test volumes, global percentage of tests that were within TAT cutoffs, and percentile statistics.

Results: Nine steps were used to develop the dashboard iteratively, with continuous feedback for each step. The data warehouse environment conformed and stored laboratory information system (LIS) data in two formats: (1) fact and (2) dimension. Queries were developed to generate an aggregate TAT data extract to create the dashboard. The dashboard successfully delivered weekly TAT reports.

Conclusion: Implementation of a TAT dashboard can successfully enable the delivery of near real-time information and provide a weekly snapshot of efficiency in the form of TAT performance to identify and quantitate bottlenecks in service delivery.

Keywords: turn-around time, laboratory efficiency, interactive dashboard, indicators, performance assessment

Introduction

|Turnaround time (TAT) is an important performance indicator for a laboratory service. It refers to the time from first registration in a laboratory to a result released in the laboratory information system (LIS). Historically, within the National Health Laboratory Service (NHLS) of South Africa, TAT reporting was provided in annual and quarterly static management reports generated by the LIS, TrakCare, which also provided ad hoc reporting for use at the laboratory level. These reports are printed to provide a snapshot of TAT reporting and are suited for staff working at the laboratory level. At a national level, the corporate data warehouse (CDW) of the NHLS collated global TAT data from over 266 testing laboratories based on predetermined, annual performance plan cutoffs. National TAT cutoffs are set by expert committees of different pathology disciplines, with final confirmation from senior management before implementation. These cutoffs are set with provisions for all levels of the service laboratory: from low-volume laboratories with limited test repertoires to high-volume testing laboratories with extensive test offerings, including specialized testing, such as viral load testing. However, a large percentage of NHLS laboratories have 24-hour service and have emergency units in the hospitals in which they are housed; such laboratories have locally stricter TAT cut-offs for emergency and other local tests than are reflected in the national cutoffs for all samples.

Historically, the NHLS CDW TAT reports generated were static and reported only the mean TAT. Turnaround time data have a positive skewness, that is, a long tail to the right, meaning that the mean will be greater than the median. This implies that TAT data reported previously, reporting the mean TAT, masks good performance while concealing poor efficiency. Further, neither the current LIS nor CDW reports enable detailed analysis of the information or drilling down to laboratory- or test-level data for additional information about TAT efficiencies. Data presented at the first conference of the African Society for Laboratory Medicine in Cape Town, South Africa, in 2012, reported daily laboratory test volumes and mean TAT for authorized results, stratified by individual laboratories, providing a snapshot of performance. This enabled review of CD4 laboratory efficiency for a national program and provided important insights into laboratory operations.

Notes

This presentation is faithful to the original, with only a few minor changes to presentation. Grammar was cleaned up for smoother reading. In some cases important information was missing from the references, and that information was added.