The impact of a pneumatic tube and computerized physician order management on laboratory turnaround time.
OBJECTIVE
We assess the effect of sequential modifications in laboratory processing, including pneumatic tube transport and fully computerized order management, on laboratory turnaround time in the emergency department (ED).


METHODS
This was an observational analysis of a comprehensive computerized database derived from ED, laboratory, and hospital information systems. The setting was an academic urban ED with annual census of 38,000. Participants and interventions included all patients who had laboratory testing (serum sodium level, troponin level, or CBC count) during three 1-month study periods: before pneumatic tube and computerized order management (prepneumatic tube), after pneumatic tube but before computerized order management (postpneumatic tube), and after both pneumatic tube and computerized order management (postpneumatic tube/computerized order management). The primary outcome measure was median laboratory turnaround time, reported with interquartile ranges. Additional measures included ED census and number of laboratory tests ordered during each study period.


RESULTS
The monthly ED census was 3,021, 3,428, and 3,066 for the prepneumatic tube, postpneumatic tube, and postpneumatic tube/computerized order management periods. There was a significant decrease in turnaround time with each period and each test over time. For serum sodium testing, the median laboratory turnaround time decreased from 55.9 to 46.7 to 37.2 minutes for prepneumatic tube, postpneumatic tube, and postpneumatic tube/computerized order management periods. For CBC-count testing, median times decreased from 55.6 to 42.2 to 36.3 minutes, respectively. For troponin I testing, median times decreased from 52.8 to 41.8 to 30.6 minutes, respectively.


CONCLUSIONS
Changes in laboratory specimen management, including the use of a pneumatic tube and computerized order management, resulted in a progressive decrease in laboratory turnaround time in the study ED.
Guss
David A
DA
Department of Emergency Medicine, University of California, UC San Diego Medical Center, 200 West Arbor Drive, Mailcode 8676, San Diego, CA 92103, USA. dguss@ucsd.edu
Chan
Theodore C
TC
Killeen
James P
JP
D019963:Clinical Chemistry Tests / Q000706:statistics & numerical data; D002984:Clinical Laboratory Information Systems; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D006403:Hematologic Tests / Q000706:statistics & numerical data; D006784:Hospitals, Teaching; D006786:Hospitals, Urban / Q000458:organization & administration; D006801:Humans; D007755:Laboratories, Hospital / Q000458:organization & administration* / Q000706:statistics & numerical data; D050316:Medical Order Entry Systems; D016347:Medical Records Systems, Computerized; D013997:Time Factors; D017748:Time Management / Q000379:methods*; D014481:United States; D016526:Workload / Q000706:statistics & numerical data