Journal:Timely delivery of laboratory efficiency information, Part II: Assessing the impact of a turnaround time dashboard at a high-volume laboratory
|Full article title||Timely delivery of laboratory efficiency information, Part II: Assessing the impact of a turnaround time dashboard at a high-volume laboratory|
|Journal||African Journal of Laboratory Medicine|
|Author(s)||Cassim, Naseem; Coetzee, Lindi M.; Tepper, Manfred E.; Perelson, Louella; Glencross, Deborah K.|
|Author affiliation(s)||National Health Laboratory Service, University of the Witwatersrand|
|Primary contact||Email: naseem dot cassim at wits dot ac dot za|
|Volume and issue||9(2)|
|Distribution license||Creative Commons Attribution 4.0 International License|
|This article should be considered a work in progress and incomplete. Consider this article incomplete until this notice is removed.|
Background: In South Africa’s National Health Laboratory Service, ad hoc mean turnaround time (TAT) reporting is an important indicator of performance. However, historic static TAT reporting did not assess very long or very short times. An interactive TAT dashboard was developed using the following TAT measures: (1) median, (2) 75th percentile, and (3) percentage of within cutoff TAT to allow for improved differentiation of TAT performance.
Objectives: The objective of our study was to demonstrate increased efficiency achieved by using an interactive TAT dashboard.
Methods: A retrospective descriptive study design was used. Creatinine TAT outcomes were reported over 122 weeks from a high-volume laboratory in Gauteng, South Africa. The percentage of within cutoff and 75th percentile TAT were analyzed and reported using Microsoft Excel. A focus group session was used to populate a cause and effect diagram.
Results: The percentage of within cutoff TAT increased from 10% in week four to 90% and higher from week 81. The 75th percentile decreased from 10 hours in week four to under five hours from week 71. Component TAT analysis revealed that the 75th percentile testing was five hours or longer for weeks four, five and 48. The 75th percentile review TAT ranged from one hour to 15 hours. From week 41, the review TAT was under one hour.
Conclusion: Our study demonstrated that the use of an interactive TAT dashboard, coupled with good management, can dramatically improve TAT and efficiency in a high-volume laboratory.
Keywords: turnaround time, laboratory efficiency, pathology, laboratory medicine
Turnaround time (TAT) is an important performance indicator of a laboratory's efficiency in delivering patient results. In the South African National Health Laboratory Services, ad hoc mean TAT reports were previously produced for laboratory managers. These TAT reports assessed performance based on the National Health Laboratory Service global annual performance plan (APP) TAT cutoffs specific to individual tests. Reports were provided intermittently in a static form that assessed central tendency only (i.e., the tail size was not reported) and did not allow for drilling down to access additional, more detailed information to direct meaningful corrective action (i.e., laboratory or sample-level TAT breakdown). To improve on these TAT reporting systems, Coetzee et al. used three additional measures to assess TAT efficiency: (1) median TAT, (2) 75th percentile TAT (tail size), and (3) percentage of within cutoff TAT. These measures accurately assessed outliers as tail size and could be used by laboratories to address workflow issues and identify testing delays for intervention. "Tail size" refers to the volume of samples in a positively skewed data distribution that has a long tail to the right. These samples often have a much higher TAT value than the central tendency (median) for this data distribution. Tail size can be measured as the percentage of samples that exceed a defined TAT cutoff in hours, or as a percentile.
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- Coetzee, L.M.; Cassim, N.; Tepper, M.E.E. et al. (2018). "The importance of reporting individual weekly laboratory turn-around-time (TAT) to identify outliers and underperformance masked during global annual TAT review". Proceedings of the African Society for Laboratory Medicine Conference 2018. https://www.researchgate.net/publication/329610644.
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. The original citation number two (2017-2018 NHLS Annual Report) was dead; an alternately hosted version was found and used for this version.