Study Of Key Quality Indicators For Clinical Laboratories: Timeliness Of Critical Values Reporting And Total Turnaround Time

ObjectiveThe aim of the study was to catch up with the state of art, provide base data for developing quality specifications of related quality indicators (Qls). analyze influence factors and give advice to labs on timeliness of critical values reporting and total turnaround time (TAT).MethodsQuestionnaires were provided to clinical labs participating in the external quality assessment programs organized by the National Centre for Clinical Laboratories in China in July 2015 through network platform.5 Qls were included in critical value reporting timeliness investigation for biochemistry, haematology and blood gas tests, which were critical value unreported rate, unreported timely rate, clinical unacknowledged rate, median and P90 of reporting time.12 Qls were included in total TAT investigation for biochemistry, haematology, blood gas and automatic immunology tests, which were median, P90 and outlier rates of pre-examination, examination, post-examination and total TAT. Reasons of unreported critical value and delayed TAT were also investigated. Self-developed statistical software was used for data analysis after information collection.ResultsResponse rates of critical value reporting timeliness for biochemistry, haematology, and blood gas tests were 62.62%,63.72%, and 86.81% respectively. Majority of participating labs were third-class comprehensive hospitals. Almost all labs had critical value reporting policy in place and provided related training for their staff. The critical value unreported rate, unreported timely rate, and clinical unacknowledged rate of most participants were all 0.00%(6σ). Major schedule time of critical reporting were 10-20min or 30-40min. Most participants had reported 90% of their critical values within 15min and reported all critical values within 30min. Common reasons for unreported critical values includes "Laboratory staff reporting missing", "communications equipment failure or unable to connect", "uncompleted application form without contact information of clinician" and "repeat critical values" and so on.Response rates of total TAT for biochemistry, haematology, blood gas and automatic immunology tests were 46.44%,50.10%,83.51% and 51.11%, respectively. Majority of participating labs were third-class comprehensive hospitals. The percentages of Labs which had monitored pre-examination, examination, post-examination and total TAT in their daily work were 52.29%,80.39%,55.22% and 56.00%, respectively. The post-examination TATs of most Labs were Omin, while pre-examination, examination and total TAT varied largely among different subjects. The median and P90 of pre-examination, examination and total TATs for biochemistry tests were higher than which of haematology tests. Automatic immunology tests were similar with biochemistry tests. While the median and P90 of pre-examination, examination and total TATs were lowest for blood gas tests among four subjects. The sigma values of total TAT outlier rates for about 45～60% of participants were all above 4, while there still were about 15～20% of labs whose sigma values were below 3. The outlier rates of pre-examination TAT were higher than other phases. Participants believed that the reasons of delay of pre-examination, examination and post-examination TAT were "long transportation time", "Peak time instruments congestion" and "LIS/HIS breakdown", respectively. Group comparisons showed nurse or mechanical pipeline transportation, linking LIS with HIS, and using computer reporting instead of printing report were related to shorter TATs.ConclusionsLabs usually pay huge attention on critical value reporting and the performances of it were quite satisfied. However, although most labs had monitored examination TATs in their daily work, the monitoring strength of pre-examination, post-examination and total TATs were insufficient. Clinical labs were recommended to set critical value reporting schedule time between 15min and 30min, and set target TATs referring to related data in this study and other literatures with the consultation of clinicians. Meanwhile they should strengthen the construction of information systems, identify reasons for critical value reporting delay and TAT delay through lengthways internal monitoring and transverse external comparison, so that the service quality can be continuously improved.