Medical laboratories have employed Quality Indicators to help assess their performance for many years. One of these quality indicators, while debated among laboratory professionals and physicians, is the Turn-around-time for reporting results. There are many different ways that this is calculated, and different types of tests certainly have different acceptable limits for reporting results. “TAT is time of specimen receipt in the laboratory to time of results reporting. However, order-to-reporting TAT is the most common clinician definition for TAT.” In some way, all agree (particularly physicians) that TAT is an important metric although how exactly the TAT goal should be determined is yet to be agreed upon. Improving the turn around time of reporting some key test results has a positive impact on patients and the healthcare system if that means faster diagnosis and reducing hospitalization times.
An estimated TAT goal in the Lab Medicine article “Evaluating Laboratory Performance With Quality Indicators” is 5-5.5 hours for non-stat or routine tests. The NCBI states that “A 90% completion time (sample registration to result reporting) of <60 minutes for common laboratory tests is suggested as an initial goal for acceptable TAT.”
If we were to apply the same logic to EQA samples and used the measure of TAT as time of specimen receipt in the laboratory to time of results reporting, we would expect that all results would be reported within the first day or few days of the test event, allowing for some shipment delays. A graphic showing the reporting of EQA results for our April test event in Canada is shown below. Unfortunately, we see a widening gap between the standard line and the actual graph as we get further from the start of the test event.
EQA best serves its purpose when EQA samples are treated as patient samples. We encourage our participants to submit their results as they would for routine patient tests.
Now for PT providers, if TAT is a Quality Indicator for medical laboratories then why shouldn’t it be a quality indicator for your PT provider. Oneworld Accuracy will be implementing a TAT Quality Indicator for issuing performance reports that we will publish in our newsletter and our new website (coming soon). Similarly to your laboratory tests, we feel that the TAT of our performance evaluations in PT should be improved and that this will have a positive impact on you in simplifying your workload, improving your ability to correct errors faster and subsequently minimizing negative effects of variable testing on patients.
Starting in the April event, we implemented soft deadlines for completing our evaluations. The April test event closed on April 17, 2019. Our goal was to have all performance reports released to participants by May 8, 2019. Our soft goal was a TAT of 21 days. A graphic of our success is shown below comparing test event 3 of last year and test event 1 of this year. This means that all of our participants received most of their performance reports faster than what they did last year. Over 98% of our programs saw an evaluation completed in less time than that of test event 3 of last year. While we still have a few complex Serology programs were evaluated late, 94% of our programs were evaluated within 21 days.
While we are working on what our TAT goal should be, we are proud to say that we are improving. Our goal is to have some programs with instant evaluations. Like the argument being made for POC testing, we see how instant evaluations could be beneficial in many cases in getting results to you quicker for less complex testing. Our development team is looking into options to provide instant evaluations for some programs in the future.
We will keep you informed of our Quality Indicators, TAT and other, in our upcoming newsletters.
Chawla et al. (2010, May). Evaluating Laboratory Performance With Quality Indicators. Laboratory
Medicine, Volume 41, Issue 5, Pages 297–300. Retrieved from https://academic.oup.com/labmed/article/41/5/297/2504945
Hawkins (2007, Nov) Laboratory Turnaround Time. Clin Biochem Rev.; 28(4): 179–194. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2282400/
Shahangian, S. Snyder (2009, March) Laboratory Medicine Quality Indicators: A Review of the Literature. American Journal of Clinical Pathology, Volume 131, Issue 3, Pages 418–431. Retrieved from https://academic.oup.com/ajcp/article/131/3/418/1760952