title: Process Optimization to Improve Immunosuppressant Drug Testing Turnaround Time.
abstract: OBJECTIVE
  Timely reporting of immunosuppressant (ISP) drug level results is needed for transplant patient management. This study characterized the local ISP testing process, identified bottlenecks and implemented process improvements to meet turnaround time requirements.
  
  
  METHODS
  Laboratory information time stamps, direct observation and discussion with staff were used to construct a value stream map of the ISP testing process to identify process bottlenecks. Improvements were implemented to attain the required turnaround time.
  
  
  RESULTS
  Baseline performance of the existing ISP process (seven weeks, n = 272 samples) indicated that only 28% of samples were reported by 2:00 pm Major bottlenecks were identified to be the analytical run schedule, instrument delays, difficulty identifying ISP samples at intake, and difficulty collecting specimens. Process changes resulted in a median of 76% samples reported by 2:00 pm
  
  
  CONCLUSIONS
  : Adjusting ISP collection and analysis processes improved the laboratory's ability to meet physician requested result reporting time of 2:00 pm.
authors.affiliation: From the Department of Pathology and Laboratory Medicine, Children's and Women's Health Centre of British Columbia, Vancouver, Canada Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Canada.
authors.forename: Vilte E
authors.initials: VE
authors.lastname: Barakauskas
authors.affiliation: ARUP Laboratories, Salt Lake City, UT.
authors.forename: Tiffany A
authors.initials: TA
authors.lastname: Bradshaw
authors.affiliation: University of Utah Health Care, Pharmacy Transplant Services, Salt Lake City.
authors.forename: Lonnie D
authors.initials: LD
authors.lastname: Smith
authors.affiliation: Department of Pathology, University of Utah Health Sciences Center, Salt Lake City.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Lehman
authors.affiliation: Department of Pathology, University of Utah Health Sciences Center, Salt Lake City ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT. kamisha.johnson-davis@aruplab.com.
authors.forename: Kamisha L
authors.initials: KL
authors.lastname: Johnson-Davis
mesh_terms: D001774:Blood Chemical Analysis / Q000379:methods*; D016903:Drug Monitoring / Q000379:methods*; D006801:Humans; D007166:Immunosuppressive Agents / Q000097:blood*; D007755:Laboratories, Hospital; D017064:Process Assessment, Health Care / Q000379:methods*; D013048:Specimen Handling / Q000379:methods*
chemical_list: D007166:Immunosuppressive Agents
keywords: Hospital laboratory; Immunosuppressants; Process improvement; Process optimization; Run chart; Turnaround time; Value stream map