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TURN AROUND TIME OF LAB
DR. A.K. KHANDELWAL
Consultant Hospital Management
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WHAT IS TAT?
The laboratory's perception :TAT is from the
time the specimen is received to the analysisis completed.
Physicianss perception. : TAT is from the
order is written to the result is available
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IMPORTANCE
Efficiency of clinicians increased
Decreased Hospital stay
Increased customer satisfaction
Increased hospital business
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TAT Benchmarks
At present, TATs for most stat clinical laboratory
tests are less than 1 hour and 2 working days formost routine surgical pathology cases
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Time Required by Biochemistry Analyser
sample put to centrifuser for serum separation-------30-45min-------------/+Water bath----5min-----------serum put in
analyzer--------30min-------------/ another30 min if recheck-------Report is generated10min-------preliminary reportavailable.Total Time- 75 min to105 min
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Time Required for CBC by Cell Counter
Sample put in rotator for proper mixing---------10min---------sample put to machine-------3-4 min---report is generated--------preliminary report is available
Total time- 15 min.
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All laboratory tests can be divided into three
phases: preanalytic, analytic, and postanalytic.
Preanalytic-the time required to requisition,
collect, and transport specimens;
Analytic-the time required to prepare specimens
and perform the analysis;
Postanalytic-the time required to report results
back to the patient's physician
Three phases laboratory tests
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The literature has shown that the analytic phase of the
TAT is not commonly the area in need of improvement,
and the preanalytic and postanalytic phases are morefrequently to blame for a delayed result.
With modern instrumentation, analysis time comprises
only 1% to 3% of the TAT.
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Technology has allowed for the innovations necessary for
the improvement of the TAT.
Since a TAT has three phases, preanalytic, analytic, and
postanalytic, these technologies have been designed for
improvement at the particular phase of interest.
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It is usually the analytic phase with which the laboratory
personnel are more concerned, but, to analyze and improve
TATs, all three phases have to be examined because
deficiencies can occur at any level .
The deficient phase has to be targeted so the solution can be
presented.
How to improve TAT
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Pneumatic Tubing System,
Satellite Laboratory,
Point Of Care Testing(bed Side Testing)
Improved Computer Technology
Successful solutions for improving TAT
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A pneumatic tubing system consists of stations throughout
the hospital with a tube interconnecting them. Carriers
can be placed in the tubes to carry samples to a desired
destination.
Study revealed that pneumatic tubing system expedite
transport of specimens to the laboratory with time range
for specimen coming from different locations of 30 to 43
seconds.
Pneumatic Tubing System
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Computers have the capability of reducing TAT at all
phases.
Order can go directly from the department to the
laboratory.
Instruments can be interfaced so that results go directly
into the computer.
After results are reviewed by laboratory personnel, theyare then readily available to the ordering physician to
access via the computer
Computer Technology
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Laboratory information system (LIS) is a fundamental
building block in the development of a laboratoryautomation system (LAS).
Studies revealed that use of a computer has reduced
the TAT anywhere from 25% to 50%.
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Point-of-Care Testing
Point-of-care testing (POCT) is by definition a bedside
or near-bedside test.
POCT is aimed at reducing TAT at every phase.
The collection, analysis, and review of results are
performed within minutes at the location of the patient.
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Satellite laboratories exist outside of the central laboratory,
usually in areas of the hospital where rapid patient care is
essential.
Setting up a satellite laboratory can help reduce the preanalytic
portion of the TAT, but the postanalytic problems will still exist
But satellite laboratory has had mixed reviews and furtherstudies are needed to demonstrate effectiveness.
Satellite Laboratory
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Step -Test selection and order entry
Standardize nomenclature for easy lookup
Customize screens for rapid ordering
Enable providers to order electronically
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. Ensure accuracy of admission, discharge, transferdata updates (for patient location)
Consider patient location tracking
Automate lookup of information on volume,
container, and special precautions for obtaining andhandling specimens.
Step-Specimen collectionand delivery
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Element- ActionsPhlebotomy Scrutinize phlebotomy practicesSpecimen labeling Use bar codesSpecimen delivery pneumatic tubeSpecimen type Review use of plasma and serum separator
tubes and whole blood
Specimen arrival Use bar code readers
Specimen sorting Evaluate use of front-end automation: sorts,centrifuges, decaps, and prepares aliquots Sample directly fromspecimen container (as appropriate)
Step-Accessioning
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Step- Reporting
Adopt efficient quality control procedures
Interface instrumentation to computer
Generate preliminary reports
Transmit reports via computer, broadcast(electronic board),pager, and/or Internet.
Consider automatic printing for locations such as
intensive care units
Provide assistance with results and interpretation(help desk, interpretive reports,reflex testing
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Consider total laboratory automation
Ensure minimal downtime and adequacy of
backup. Use automatic repeats (for abnormal results)
and dilutions for results exceeding Linearity
Consider automatic verification of results
within reference limits
Steps- Testing
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The laboratory has to function to give patients the best
and fastest care possible.
Rapid TAT is important both from a medical andcommercial point of view.
In the era of cost consciousness , competion and Consumer
awareness hospitals cannot afford to have Slow TAT and
lose customers because of poor satisfaction with service.
Conclusion