title: Root cause analysis of laboratory turnaround times for patients in the emergency department.
abstract: BACKGROUND
  Laboratory investigations are essential to patient care and are conducted routinely in emergency departments (EDs). This study reports the turnaround times at an academic, tertiary care ED, using root cause analysis to identify potential areas of improvement. Our objectives were to compare the laboratory turnaround times with established benchmarks and identify root causes for delays.
  
  
  METHODS
  Turnaround and process event times for a consecutive sample of hemoglobin and potassium measurements were recorded during an 8-day study period using synchronized time stamps. A log transformation (ln [minutes + 1]) was performed to normalize the time data, which were then compared with established benchmarks using one-sample t tests.
  
  
  RESULTS
  The turnaround time for hemoglobin was significantly less than the established benchmark (n = 140, t = -5.69, p < 0.001) and that of potassium was significantly greater (n = 121, t = 12.65, p < 0.001). The hemolysis rate was 5.8%, with 0.017% of samples needing recollection. Causes of delays included order-processing time, a high proportion (43%) of tests performed on patients who had been admitted but were still in the ED waiting for a bed, and excessive laboratory process times for potassium.
  
  
  CONCLUSIONS
  The turnaround time for hemoglobin (18 min) met the established benchmark, but that for potassium (49 min) did not. Root causes for delay were order-processing time, excessive queue and instrument times for potassium and volume of tests for admitted patients. Further study of these identified causes of delays is required to see whether laboratory TATs can be reduced.
authors: Emergency Medicine, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada. christopher_fernandes@sympatico.ca
authors: Christopher M B
authors: CM
authors: Fernandes
authors: Andrew
authors: A
authors: Worster
authors: Stephen
authors: S
authors: Hill
authors: Catherine
authors: C
authors: McCallum
authors: Kevin
authors: K
authors: Eva