Decreased Clinical Laboratory Turnaround Time After Implementation of a Collection Manager System

Patient safety and specimen analysis turnaround time are of utmost importance in the clinical laboratory of a busy tertiary care hospital. Many institutions have employed lean and Six Sigma strategies to improve these metrics.^1–3  At our institution, a 635-bed hospital with an average daily census of 423 patients and an average daily laboratory volume of 4770 billed procedures, the prior system of specimen collection and accessioning for routine inpatient laboratory studies had several points of redundancy and waste, including multiple specimen labeling steps, multiple specimen/requisition sheet reconciliation steps, and a time-consuming requirement for phlebotomists to access the electronic medical record to log in specimens (Figure). Additionally, this process promoted batch specimen processing, further unnecessarily prolonging laboratory testing turnaround time. With the goals of improving workflow and patient safety in mind, the Sunquest Collection Manager (Sunquest Information Systems, Tucson, Arizona), a module specific for Sunquest Laboratory (Sunquest, Tucson, Arizona), was introduced in January 2013 as an addition to our existing Sunquest Laboratory laboratory information system, quickly followed by rollout in the critical care areas for use by nursing. This system allows for direct input of physician laboratory orders into the hospital laboratory information system and printing of bar code labels at the bedside, after positive patient identification using a handheld device and accompanying portable printer. As specimens are drawn, they are sent via a tube system to the laboratory, leading to a workflow more closely resembling single-specimen processing. When the specimens arrive in the laboratory, they are immediately scanned and sent for analysis. Use of the Sunquest Collection Manager eliminates two requisition/specimen reconciliation steps, both by phlebotomists on the inpatient floor and in the laboratory upon specimen arrival (Figure). The improvement in workflow resulted in a median reduction in routine laboratory turnaround time, as measured from specimen collection to specimen result, of 10 minutes (P < .001, Mann-Whitney U test; Table), or a decrease of 13% compared with the turnaround time prior to institution of the Sunquest Collection Manager. The bar coding system with bedside patient positive identification also has the potential to significantly decrease mislabeled and unlabeled specimens; however, in our study not enough time had elapsed to see a significant difference in these metrics compared with our previous system. Ultimately, in the current health care environment where every moment counts, and where morning laboratory results are often necessary for clinical decision making and timely discharge of patients, improvement of turnaround time for morning laboratory results has the potential to not only improve patient care but also improve efficiency within the hospital with regard to length of stay and related metrics.