title: Laboratory-based clinical audit as a tool for continual improvement: an example from CSF chemistry turnaround time audit in a South-African teaching hospital.
abstract: BACKGROUND
  Timeliness of laboratory results is crucial to patient care and outcome. Monitoring turnaround times (TAT), especially for emergency tests, is important to measure the effectiveness and efficiency of laboratory services. Laboratory-based clinical audits reveal opportunities for improving quality. Our aim was to identify the most critical steps causing a high TAT for cerebrospinal fluid (CSF) chemistry analysis in our laboratory.
  
  
  METHODS
  A 6-month retrospective audit was performed. The duration of each operational phase across the laboratory work flow was examined. A process-mapping audit trail of 60 randomly selected requests with a high TAT was conducted and reasons for high TAT were tested for significance.
  
  
  RESULTS
  A total of 1505 CSF chemistry requests were analysed. Transport of samples to the laboratory was primarily responsible for the high average TAT (median TAT = 170 minutes). Labelling accounted for most delays within the laboratory (median TAT = 71 minutes) with most delays occurring after regular work hours (P < 0.05). CSF chemistry requests without the appropriate number of CSF sample tubes were significantly associated with delays in movement of samples from the labelling area to the technologist's work station (caused by a preference for microbiological testing prior to CSF chemistry).
  
  
  CONCLUSIONS
  A laboratory-based clinical audit identified sample transportation, work shift periods and use of inappropriate CSF sample tubes as drivers of high TAT for CSF chemistry in our laboratory. The results of this audit will be used to change pre-analytical practices in our laboratory with the aim of improving TAT and customer satisfaction.
authors.affiliation: Department of Chemical Pathology, Tygerberg Hospital, National Health Laboratory Service (NHLS) and University of Stellenbosch, Cape Town, South Africa.
authors.forename: Lucius C
authors.initials: LC
authors.lastname: Imoh
authors.affiliation: Department of Chemical Pathology, Tygerberg Hospital, National Health Laboratory Service (NHLS) and University of Stellenbosch, Cape Town, South Africa.
authors.forename: Mubanga
authors.initials: M
authors.lastname: Mutale
authors.affiliation: Department of Chemical Pathology, Tygerberg Hospital, National Health Laboratory Service (NHLS) and University of Stellenbosch, Cape Town, South Africa.
authors.forename: Christopher T
authors.initials: CT
authors.lastname: Parker
authors.affiliation: Department of Chemical Pathology, Tygerberg Hospital, National Health Laboratory Service (NHLS) and University of Stellenbosch, Cape Town, South Africa.
authors.forename: Rajiv T
authors.initials: RT
authors.lastname: Erasmus
authors.affiliation: Department of Chemical Pathology, Tygerberg Hospital, National Health Laboratory Service (NHLS) and University of Stellenbosch, Cape Town, South Africa.
authors.forename: Annalise E
authors.initials: AE
authors.lastname: Zemlin
mesh_terms: D002555:Cerebrospinal Fluid / Q000737:chemistry*; D054869:Clinical Audit; D004636:Emergency Service, Hospital; D006784:Hospitals, Teaching; D006801:Humans; D007755:Laboratories, Hospital / Q000592:standards*; D013019:South Africa; D013997:Time Factors
keywords: CSF chemistry; continual improvement; laboratory audit; quality indicator; turnaround time