To improve turnaround time in the laboratory is an important benchmark that all medical labs strive for. However, improving turnaround time is rarely a matter of implementing one-size-fits-all solutions; it requires participation from the entire team and implementing strategies that make sense within the lab’s framework.
#1 – Implement Lean & Six Sigma
Lean and Six Sigma principles have been continually employed in medical laboratories throughout the last decade. Originally applied in manufacturing, Lean is used to systematically remove “waste,” or anything that does not contribute value to a product or service. Six Sigma is used to improve process quality, eliminating defects in the process. This is accomplished through a problem-solving methodology consisting of defining, measuring, analyzing, improving, and controlling (DMAIC). These principles, when applied to medical laboratories, can significantly decrease turnaround time. This can be done by pinpointing crucial areas of workflow that can be modified and providing optimal—and cost-effective—solutions that can be tailored to tight budgets.1
It’s worth noting that many of the tools listed below can be applied as solutions when utilizing Lean and Six Sigma principles. As each lab is different, not every tool will generate positive value with regards to turnaround time, though. It is therefore up to laboratory personnel and other decision makers to carefully and thoroughly plan, analyze, and test the options that are likely to work best.
#2– Install Middleware
Middleware systems serve as an interface between your laboratory information system (LIS) and all other laboratory equipment, often providing real-time dashboards and reports. This allows technicians and technologists to perform instant evaluations on turnaround time as well as quality control to ensure instruments are operating uniformly and accurately. It often also offers a host of additional features, such as rule-based decision support, auto-verification, and sample management functions.4
#3 – Automate to improve turnaround time
Laboratory automation is an effective way to reduce manual sample processing steps, providing personnel the ability to perform other tasks while samples are being prepared and analyzed. Automation can even be implemented on a small scale, with automated systems that centrifuge, decap, aliquot, label, and sort sample tubes available, which can reduce turnaround time for both stat and routine samples. It’s important that all automated equipment integrate with the lab’s LIS and middleware, so that staff can accurately monitor the status of all samples and automated tools.2 Furthermore, automation can minimize the rate of human errors, thus ensuring a higher quality of service to the patient.
#4 – Use auto-verification
Auto-verification, performed via middleware or LIS, is a means of verifying test results via computer-based rules without manually intervening. These rules are used to identify potentially nonsensical results and include decisions regarding a wide variety of checks and values. This includes error flags, reference ranges, critical values, interference indices, analytical measurement ranges, and delta checks. By performing auto-verification, you can improve turnaround time by allowing staff to focus on a handful of problematic samples instead of thousands of results per shift. It can also help identify rare events missed by manual verification.3
#5 – Employ the right barcodes and labels
Barcode failure represents a major hurdle to optimizing lab turnaround time. Unreadable barcodes necessitate re-labeling of the sample, a process that can cost upwards of five minutes per sample and can lead to demotivated lab personnel.5 The most reliable type of printer for generating high-quality barcodes is a thermal-transfer printer, which ensures the barcodes are resistant to abrasion, chemical exposure, and other harsh laboratory environments. Xylene-resistant labels may be of particular use, as they withstand not only histochemical reagents like xylene, eosin, and hematoxylin, but also chemicals that may leak and damage the label during sample transportation, such as formalin.
#6 – Centralize areas for equipment
Laboratory layout is an area that can often be improved upon to decrease turnaround time, as centralizing equipment can save staff from wasting time transporting samples back and forth. When configuring your lab, it’s worth developing an affinity diagram to determine which lab divisions closely share resources. Basing equipment placement on a logical plan according to one or more determining factors is ideal, as it directly addresses the needs of the lab. For instance, if one of the significant factors is the volume of incoming samples, it’s best to keep your division with the highest number of incoming samples closest to the specimen intake area, allowing them to be processed much faster.6
#7 – Reduce the time between sample arrival and accessioning
Though many labs focus on the “accessioning-to-result” portion of their turnaround time, it’s also worth assessing whether the time required between sample arrival and accessioning (accepting samples and entering sample data into a LIS) can be reduced, thus improving total turnaround time. There are several ways to avoid delays in accessioning depending on the needs of your lab, including redesigning workflow, adding more staff, and promoting the use of electronic order entry and barcode label printing prior to samples arriving at the lab. Automated systems can also prove beneficial by freeing staff from performing preanalytical tasks and allowing them to accession samples instead.7
#8 – Adapt centrifuges for turnaround time
There are three ways centrifuges can be adapted to improve turnaround time:8
- Centrifuges with digital displays and LED indicators can be purchased in lieu of those with just audible alerts, giving additional indication that a cycle has completed. This ensures tubes aren’t left inside the centrifuge and that the next cycle is started as soon as possible.
- In contrast to a single large centrifuge, centrifuge arrays can be loaded rapidly without having to wait for a previous cycle to end. An array of small, compact centrifuges may also be easier to reposition and fit in labs where space is an issue.
- Recommended by the Clinical & Laboratory Standards Institute, horizontal centrifuges have a few advantages over fixed-angle ones, such as reducing spin time by 1/3 and yielding fewer compromised samples.
#9 – Provide additional training
When implementing new technologies, training is key as it ensures staff understand their responsibilities and are kept up to date on the latest equipment, software, and procedures. Merely training laboratory staff is not enough either; it’s important to properly train, where possible, those who are responsible for delivering medical samples to the lab as well, so that consistency is maintained from the start.
- Inal TC, Goruroglu Ozturk O, Kibar F, et al. Lean six sigma methodologies improve clinical laboratory efficiency and reduce turnaround times. J Clin Lab Anal. 2018. doi:10.1002/jcla.22180
- Angeletti S, De Cesaris M, Hart JG, et al. Laboratory Automation and Intra-Laboratory Turnaround Time: Experience at the University Hospital Campus Bio-Medico of Rome. J Lab Autom. 2015;20(6):652-658.
- Krasowski M, Kulhavy J, Morris C, et al. Autoverification in a core clinical chemistry laboratory at an academic medical center. J Pathol Inform. 2014;5(13):1-17.
- Riben M. Laboratory Automation and Middleware. Surg Pathol Clin. 2015;8(3):175-186.
- Jensen K, Haniff R, Kamarinos A, Rosenberg A, Santiago M, Laser J. Improving Turnaround Times Through a Process Improvement Initiative Involving Barcoding, Floorplans, Dual Measuring Cells, Chemistry Analyzers, and Staff Shifts. J Appl Lab Med. 2019;4(3):311-322.
- McElhiney B, Todd H, Longshore JW. Using Lean Principles to Design a Centralized Laboratory. Med Lab Manag. 2016;5(10):2.
- Stotler BA, Kratz A. Determination of turnaround time in the clinical laboratory. Am J Clin Pathol. 2012;138(5):724-729.
- Varanelli J KJ. Improving STAT Turnaround Time with Minimal Process Change. AACC. https://www.aacc.org/publications/cln/cln-industry-insights/2019/improving-stat-turnaround-time-with-minimal-process-change.