The effect of laboratory automation on intra-laboratory turnaround time

The Effect of Laboratory Automation on Intra-Laboratory Turnaround Time Background: Intra-laboratory turnaround time (TAT) is a key indicator of total laboratory performance. The aim of our study was to evaluate the intra-laboratory TAT of Hafsa Sultan Hospital Central Laboratory after laboratory automation (TLA) implementation (October-December 2016) and to compare it to that in the preautomation period (October-December 2015). Method: Intra-laboratory TAT was evaluated both as the mean TAT enrolled and the percentage of outlier (OP) exams. Mean, median and percentage of outlier (OP) for IR-TAT were compared as pre and post automation using seven representative tests (Albumin, Alanin Aminotransferaz (ALT), Urea, Potassium, Beta Human Chorionic Gonodotrophin (β-hCG), Troponin I, Thyroid Stimulating Hormone (TSH)) based on different methods and requests. Comparison tests were carried out using t test in OpenEpi program. Results: The mean IR-TAT for routine Albumin, ALT, Urea, Potassium, β-hCG, Troponin I and TSH were; 105.6, 105, 104.4, 104.5, 122.8, 112.5 and 133.6 minutes, respectively at the post TLA period. We found a decrease in all mean IR-TAT and OP's except for β-hCG, Troponin I and TSH. For urgent tests mean IR-TAT were 64.9, 62.8, 62.7, 61.2, 68.7, 50.4, 75.8 minutes respectively again at the post TLA period. Longer mean IR-TAT with the unexpected volume increase (%32.8) was the effect detected in urgent samples. Stat tests were introduced for Emergency department and sample type changed from serum to plasma as corrective action for Troponin I. The mean IR-TAT for stat tests for Albumin, ALT, Urea, Potassium, β-hCG, and Troponin I were; 38.8, 38.1, 38, 38.1, 61.2 and 41.9 minutes respectively in July-September 2017. When outliers were examined at 60 minutes, all except for β-hCG were found to be <10%. The outliers for the emergency tests were <10% for all at 180 minutes. Conclusion: TLA helps to efficiently manage large volumes of samples. However, the longer IR-TAT of urgent samples yielded a need for stat implementation with manual processing at both the initial centrifugation stage and front loading directly on to a new analyzer. Step by step corrective strategies such as stat implementation and change of sample type resulted in definite IR-TAT improvement.