Improved Sample Retrieval and Turnaround Time in the Clinical Laboratory with a Spreadsheet Template for Sample Storage

Abstract Context.—Monitoring customer satisfaction is a valuable component of a laboratory quality improvement program. Objective.—To survey the level of physician satisfaction with hospital clinical laboratory services. Design.—Participating institutions provided demographic and practice information and survey results of physician satisfaction with defined aspects of clinical laboratory services, rated on a scale of 1 (poor) to 5 (excellent). Results.—One hundred thirty-eight institutions participated in this study and submitted a total of 4329 physician surveys. The overall satisfaction score for all institutions ranged from 2.9 to 5.0. The median overall score for all participants was 4.1 (10th percentile, 3.6; 90th percentile, 4.5). Physicians were most satisfied with the quality/reliability of results and staff courtesy, with median values of excellent or good ratings of 89.9%. Of the 5 service categories that received the lowest percentage values of excellent/good ratings (combined scores of 4 and 5), 4 were related to turnaround time for inpatient stat, outpatient stat, routine, and esoteric tests. Surveys from half of the participating laboratories reported that 96% to 100% of physicians would recommend the laboratory to other physicians. The category most frequently selected as the most important category of laboratory services was quality/reliability of results (31.7%). Conclusions.—There continues to be a high level of physician satisfaction and loyalty with clinical laboratory services. Test turnaround times are persistent categories of dissatisfaction and present opportunities for improvement.

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Hospital Nursing Satisfaction With Clinical Laboratory Services: A College of American Pathologists Q-Probes Study of 162 Institutions

Archives of Pathology & Laboratory Medicine ◽

10.5858/2006-130-1756-hnswcl ◽

2006 ◽

Vol 130 (12) ◽

pp. 1756-1761 ◽

Cited By ~ 3

Author(s):

Bruce A. Jones ◽

Molly K. Walsh ◽

Stephen G. Ruby

Keyword(s):

Quality Improvement ◽

Clinical Laboratory ◽

Turnaround Time ◽

Satisfaction Score ◽

Nursing Personnel ◽

Laboratory Management ◽

Nursing Satisfaction ◽

Laboratory Service ◽

Hospital Nursing ◽

Laboratory Services

Abstract Context.—Monitoring customer satisfaction is an important and useful quality improvement tool and is required of most clinical laboratories in the United States. Objective.—To survey the level of nursing satisfaction with hospital clinical laboratory services. Design.—Participating laboratories provided information regarding laboratory demographics and practices. These laboratories then surveyed hospital nursing personnel regarding their level of satisfaction with defined aspects of laboratory service. Setting.—College of American Pathologists Q-Probes laboratory quality improvement study in 162 hospital laboratories. Main Outcome Measures.—Nursing overall satisfaction score (ranging from 1, not satisfied, to 5, very satisfied) and satisfaction scores for 13 specific aspects of clinical laboratory services. Results.—One hundred sixty-two institutions submitted data from a total of 7033 nursing surveys. The overall satisfaction score for all institutions ranged from 2.5 to 4.6. The median overall score for all participants was 3.9 (10th percentile, 3.2; 90th percentile, 4.2). Nursing personnel were most satisfied with the accuracy of test results, phlebotomy courtesy toward patients and nursing staff, and notification of abnormal results. They were least satisfied with stat test turnaround time, laboratory management responsiveness and accessibility, phlebotomy responsiveness to service requests, and routine test turnaround time. The most important aspect of laboratory service reported by nursing personnel was stat test turnaround time. Conclusions.—Most nursing personnel are satisfied with the clinical laboratory services that are provided to the patients in their care. Although test result accuracy is very highly regarded, there is room for improvement in several aspects of service, particularly in test turnaround time and laboratory management accessibility and responsiveness.

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Third-Generation Sequencing in the Clinical Laboratory: Exploring the Advantages and Challenges of Nanopore Sequencing

Journal of Clinical Microbiology ◽

10.1128/jcm.01315-19 ◽

2019 ◽

Vol 58 (1) ◽

Cited By ~ 17

Author(s):

Lauren M. Petersen ◽

Isabella W. Martin ◽

Wayne E. Moschetti ◽

Colleen M. Kershaw ◽

Gregory J. Tsongalis

Keyword(s):

Infectious Disease ◽

Pathogen Detection ◽

Clinical Laboratory ◽

Low Cost ◽

Turnaround Time ◽

Metagenomic Sequencing ◽

Nanopore Sequencing ◽

Advantages And Disadvantages ◽

Disease Diagnostics ◽

Infectious Disease Diagnostics

ABSTRACT Metagenomic sequencing for infectious disease diagnostics is an important tool that holds promise for use in the clinical laboratory. Challenges for implementation so far include high cost, the length of time to results, and the need for technical and bioinformatics expertise. However, the recent technological innovation of nanopore sequencing from Oxford Nanopore Technologies (ONT) has the potential to address these challenges. ONT sequencing is an attractive platform for clinical laboratories to adopt due to its low cost, rapid turnaround time, and user-friendly bioinformatics pipelines. However, this method still faces the problem of base-calling accuracy compared to other platforms. This review highlights the general challenges of pathogen detection in clinical specimens by metagenomic sequencing, the advantages and disadvantages of the ONT platform, and how research to date supports the potential future use of nanopore sequencing in infectious disease diagnostics.

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A rapid, sensitive enzyme-linked immunoassay for human thyrotropin.

Clinical Chemistry ◽

10.1093/clinchem/31.7.1131 ◽

1985 ◽

Vol 31 (7) ◽

pp. 1131-1134 ◽

Cited By ~ 11

Author(s):

Y C Tseng ◽

K D Burman ◽

J R Baker ◽

L Wartofsky

Keyword(s):

Color Change ◽

Clinical Laboratory ◽

High Sensitivity ◽

Normal Subjects ◽

Turnaround Time ◽

Cross Reactivity ◽

Serum Samples ◽

Assay Sensitivity ◽

Nitrophenyl Phosphate ◽

Set Up

Abstract In this enzyme-linked immunoassay for human thyrotropin (TSH) in unextracted serum we use 96-well immunoenzymometric assay plates, first coated with polyclonal antibody to TSH, then incubated with the serum samples and reacted with mouse monoclonal antibody to human TSH. After incubation with alkaline phosphatase-labeled antibody against mouse IgG, disodium p-nitrophenyl phosphate is added and the color change is measured spectrophotometrically. Assay sensitivity is 0.1 milli-int. unit/L. Cross reactivity with lutropin, follitropin, or choriogonadotropin was negligible. TSH concentrations ranged from 0.4 to 4.1 milli-int. units/L in 43 normal subjects (mean 2.0, SD 1.0), and were uniformly less than 0.3 milli-int. unit/L in 23 patients with hyperthyroidism. Features which make this assay advantageous to the clinical laboratory include ease of set-up, ability to assay many samples at a time, high sensitivity, rapid turnaround time (8 h), and absence of requirements for radioactive materials.

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Improvement of laboratory turnaround time using lean methodology

International Journal of Health Care Quality Assurance ◽

10.1108/ijhcqa-08-2016-0116 ◽

2018 ◽

Vol 31 (4) ◽

pp. 295-308 ◽

Cited By ~ 8

Author(s):

Shradha Gupta ◽

Sahil Kapil ◽

Monica Sharma

Keyword(s):

Clinical Laboratory ◽

Value Added ◽

Turnaround Time ◽

Industrial Engineering ◽

Healthcare Sector ◽

Value Stream Mapping ◽

Content Type ◽

Laboratory Staff ◽

Tools And Techniques

Purpose The purpose of this paper is to discuss the implementation of lean methodology to reduce the turnaround time (TAT) of a clinical laboratory in a super speciality hospital. Delays in report delivery lead to delayed diagnosis increased waiting time and decreased customer satisfaction. The reduction in TAT will lead to increased patient satisfaction, quality of care, employee satisfaction and ultimately the hospital’s revenue. Design/methodology/approach The generic causes resulting in increasing TAT of clinical laboratories were identified using lean tools and techniques such as value stream mapping (VSM), Gemba, Pareto Analysis and Root Cause Analysis. VSM was used as a tool to analyze the current state of the process and further VSM was used to design the future state with suggestions for process improvements. Findings This study identified 12 major non-value added factors for the hematology laboratory and 5 major non-value added factors for the biochemistry lab which were acting as bottlenecks resulting in limiting throughput. A four-month research study by the authors together with hospital quality department and laboratory staff members led to reduction of the average TAT from 180 to 95minutes in the hematology lab and from 268 to 208 minutes in the biochemistry lab. Practical implications Very few improvement initiatives in Indian healthcare are based on industrial engineering tools and techniques, which might be due to a lack of interaction between healthcare and engineering. The study provides a positive outcome in terms of improving the efficiency of services in hospitals and identifies a scope for lean in the Indian healthcare sector. Social implications Applying lean in the Indian healthcare sector gives its own potential solution to the problem caused, due to a wide gap between lean accessibility and lean implementation. Lean helped in changing the mindset of an organization toward providing the highest quality of services with faster delivery at an optimal cost. Originality/value This paper is an effort to reduce the gap between healthcare and industrial engineering and enhancing the use of lean practices in Indian healthcare. The study is motivated toward implementing lean methodology successfully in services.

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Performance of a Semi-quantitative Multiplex Bacterial PCR Panel Compared with Standard Microbiological Laboratory Results: 396 Patients Studied with the BioFire® Pneumonia Panel

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa560 ◽

2020 ◽

Author(s):

Kenneth H Rand ◽

Stacy G Beal ◽

Kartikeya Cherabuddi ◽

Brianne Couturier ◽

Beth Lingenfelter ◽

...

Keyword(s):

Respiratory Tract ◽

Predictive Value ◽

Copy Number ◽

Clinical Laboratory ◽

Bacterial Species ◽

Turnaround Time ◽

Gram Stain ◽

Potential Pathogen ◽

Microbiological Laboratory ◽

Standard Culture

Abstract Background Microbiologic results are critical to optimal management of patients with lower respiratory tract infection, but standard methods may take several days. The multiplex PCR BioFire® Pneumonia (PN) panel detects 15 common bacterial species semi-quantitatively as copy number/mL, 8 viral species and 7 resistance genes in about an hour within the clinical laboratory. Methods We tested 396 unique endotracheal or bronchoalveolar lavage specimens with the BioFire® Pneumonia panel, and compared the bacterial detections to conventional gram stain and culture results. Results Of the 396 patients, 180 grew at least 1 bacteria that had a target on the PN panel and 177/180 (98.3%) were detected by the panel. A further 20% of patients had additional targets detected, but not found in standard culture (specificity 69%, positive predictive value 63%, and negative predictive value 98.9%). Copy number was strongly related to standard semi-quantitative growth on plates reported by the laboratory (e.g. 1+, 2+, 3+ growth), and was significantly higher in those specimens that grew a potential pathogen. Both higher copy number and bacterial detections found by the PN panel, but not found in culture, were strongly positively related to the level of WBC reported in the initial gram stain. Conclusions Higher copy number and bacterial detections per se by the PN panel are related to the host respiratory tract inflammatory response. If laboratories can achieve a rapid turnaround time, the PN panel should have a significant impact both to patient management and to antibiotic stewardship.

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MODULARANALYTICS: A New Approach to Automation in the Clinical Laboratory

Journal of Automated Methods and Management in Chemistry ◽

10.1155/jammc.2005.8 ◽

2005 ◽

Vol 2005 (1) ◽

pp. 8-25 ◽

Cited By ~ 16

Author(s):

Gary L. Horowitz ◽

Zahur Zaman ◽

Norbert J. C. Blanckaert ◽

Daniel W. Chan ◽

Jeffrey A. Dubois ◽

...

Keyword(s):

Clinical Laboratory ◽

Clinical Chemistry ◽

Control Unit ◽

Turnaround Time ◽

Chemistry Laboratory ◽

New Approach ◽

Typical Sample ◽

Clinical Chemistry Laboratory ◽

Carry Over ◽

Roche Diagnostics

MODULARANALYTICS(Roche Diagnostics) (MODULARANALYTICS, Elecsys and Cobas Integra are trademarks of a member of the Roche Group) represents a new approach to automation for the clinical chemistry laboratory. It consists of a control unit, a core unit with a bidirectional multitrack rack transportation system, and three distinct kinds of analytical modules: an ISE module, a P800 module (44 photometric tests, throughput of up to 800 tests/h), and a D2400 module (16 photometric tests, throughput up to 2400 tests/h). MODULARANALYTICSallows customised configurations for various laboratory workloads. The performance and practicability of MODULARANALYTICSwere evaluated in an international multicentre study at 16 sites. Studies included precision, accuracy, analytical range, carry-over, and workflow assessment. More than 700 000 results were obtained during the course of the study. Median between-day CVs were typically less than 3% for clinical chemistries and less than 6% for homogeneous immunoassays. Median recoveries for nearly all standardised reference materials were within 5% of assigned values. Method comparisons versus current existing routine instrumentation were clinically acceptable in all cases. During the workflow studies, the work from three to four single workstations was transferred to MODULARANALYTICS, which offered over 100 possible methods, with reduction in sample splitting, handling errors, and turnaround time. Typical sample processing time on MODULARANALYTICSwas less than 30 minutes, an improvement from the current laboratory systems. By combining multiple analytic units in flexible ways, MODULARANALYTICSmet diverse laboratory needs and offered improvement in workflow over current laboratory situations. It increased overall efficiency while maintaining (or improving) quality.

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Utilization of Stat Test Priority in the Clinical Laboratory: A College of American Pathologists Q-Probes Study of 52 Institutions

Archives of Pathology & Laboratory Medicine ◽

10.5858/arpa.2012-0100-cp ◽

2013 ◽

Vol 137 (2) ◽

pp. 220-227 ◽

Cited By ~ 11

Author(s):

Keith E. Volmar ◽

David S. Wilkinson ◽

Elizabeth A. Wagar ◽

Christopher M. Lehman

Keyword(s):

Emergency Department ◽

Patient Management ◽

Clinical Laboratory ◽

Turnaround Time ◽

Coagulation Test ◽

Testing Rate ◽

Emergency Department Patients

Context.—Utilization of stat testing priority is a balance between safe, efficient patient management and resource expenditure. Objective.—To determine the rate of stat testing, compare rates among institutions, and determine the distribution of turnaround time expectations for different turnaround time priorities. Design.—During a 7-day period, participants prospectively determined the total number of chemistry, hematology, and coagulation billable tests from inpatients and emergency department patients. Among these, the total numbers of billable tests performed stat were identified. Laboratories also reported the levels of test priority they offered and turnaround expectations for each level of test priority. Results.—Fifty institutions submitted data for the study, with 2 additional participants submitting partial results. Participants identified 639 589 chemistry, hematology, and coagulation billable tests, with 229 896 (35.9%) performed stat. The stat rate varied from 21.3% at the 10th percentile to 55.4% at the 90th percentile, with a median of 37.0% of participants' tests performed stat. Laboratories include a mean of 206 tests in chemistry, hematology, and coagulation test menus, with 67% of these tests offered stat. The fraction of the test menu offered stat varied from 29.0% at the 10th percentile to 97.8% at the 90th percentile, with a median of 73.3% of tests on the menu offered stat. The most common number of testing priorities offered by participating laboratories was 3 (44.2%). Conclusions.—Among the 52 participating laboratories, the median stat testing rate was 37.0% and a median 73.3% of the test menu was offered stat.

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Reduction in False-Positive PF4/Heparin Antibody Testing Following Implementation of a Latex Immunoturbidimetric Assay

American Journal of Clinical Pathology ◽

10.1093/ajcp/aqz112.064 ◽

2019 ◽

Vol 152 (Supplement_1) ◽

pp. S34-S34

Author(s):

Chiraag Gangahar ◽

Daniel Webber ◽

Ronald Jackups

Keyword(s):

Clinical Judgment ◽

Test Performance ◽

False Positive ◽

Clinical Laboratory ◽

Turnaround Time ◽

Serotonin Release ◽

Reference Laboratory ◽

Antibody Testing ◽

Release Assay ◽

Positive Results

Abstract Background Heparin-induced thrombocytopenia (HIT) is a life-threatening complication of exposure to heparin that is caused by autoantibodies against heparin-PF4 complexes. We recently changed our in-house HIT screening platform from a manual, daily batched ELISA (Stago-Asserochrom HPIA Immunoassay) to an automated, on-demand latex immunoturbidimetric assay (LIA, HemosIL HIT-Ab) and have also implemented a reflex from a positive LIA result to the confirmatory serotonin release assay (SRA). We compared the two methods in terms of utilization, test performance, and turnaround time. Methods Data were collected retrospectively from a 7-month period before (June-December 2017) and after (June-December 2018) implementation of the HemosIL LIA in the clinical laboratory at a large academic institution. This study includes consecutive test results from adults (median age: 64 years, range: 19-98 years) seen at our 1,300-bed main hospital. Test utilization, turnaround time (sample receipt to verification), and test performance characteristics were compared between the two methods. Repeat testing was excluded from the analysis. Samples with a positive result on the HemosIL LIA were reflexed to a serotonin release assay (SRA), performed at a large reference laboratory, whereas samples tested with the earlier ELISA assay were referred for SRA testing based upon clinical judgment. When performed, SRA was considered the gold standard for diagnosis of HIT. Results During the 7 months before and after switching methods, there were 109 of 594 (18.4%) positive ELISA results and 45 of 523 (8.6%) positive LIA results. Only 90 of 109 (82%) of the positive results from the ELISA HIT Ab test were sent out by clinicians for SRA testing, whereas 45 of 45 (100%) of the positive results from LIA testing were reflexed to SRA per protocol. Although fewer LIA tests were sent out for SRA testing, there were an equal number of SRA-confirmed cases of HIT with the ELISA (PPV: 16/90 [17.8%]) and LIA methods (PPV: 16/45 [35.6%]), resulting in a high positive predictive value (PPV) with the newly implemented method. Not only was the PPV higher with the LIA test, but it had a significantly shorter mean turnaround time of 96 minutes compared to the ELISA TAT of 1,234 minutes (P < .0001). Conclusions With the new testing protocol, patients received results faster (average 96-minute TAT) and had fewer false-positive results (74/594 pre vs 29/523 post), with no apparent reduction in detection of true-positive cases of HIT (16/594 pre vs 16/523 post).

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