Improved Laboratory Stat Test Turnaround Time Using Lean Six Sigma

Abstract

Patient safety is dependent on accurate and timely laboratory test results for diagnostic decisions and therapeutic interventions. The Laboratory at St Christopher's Hospital for Children is committed to patient safety and service excellence. Our unique challenges include pediatric sample volumes, manual specimen handling, insufficient sample quantity, and a high percentage of hemolysis and manual differentials. By using the principles of six sigma and lean processing, we embarked on a 3-year process improvement initiative to reduce the turnaround time for all stat tests from time from receipt in the laboratory to result. We created reports to monitor TAT and used the data to generate daily reports. Supervisors reviewed daily, investigated outliers for root cause and trends, and posted dashboard reports every week. Batching routine and stat chemistry tubes for centrifugation and missing manual test pending on samples that included automated tests were process problems identified. Trends by shift and time of day were reviewed and indicated a pattern of delays from 4:00 to 7:00 AM 7 days a week. Pneumatic tube delivery time stamps confirmed increased test volume for this time frame. We implemented workflow improvements with emphasis on reduction of wasted non-value-added process steps. An new stat bench was added to improve process flow and decrease wasted steps and time. Equipment to enhance spin function was purchased, and we introduced heparinized samples to reduced preanalytic processing time. Staffing to support the 4:00 AM volume was added. Data were measured, and dashboards were posted weekly by section and shift. These dashboards highlighted successes and promoted healthy competition as an incentive. We successfully achieved our target of 100% completed in 60 minutes, and we have further reduced the turnaround time for emergency department stat tests to 100% within 30 to 35 minutes.