Timely reperfusion improves the recovery of patients with acute ischemic stroke. Laboratory results are crucial to guide treatment decisions in patients where abnormal laboratory tests are suspected.
To implement a new laboratory workflow for acute stroke patients and compare laboratory turnaround time (TAT) preimplementation and postimplementation.
We conducted a retrospective pre-post intervention study of patients with suspected acute stroke during the 4-month periods before and after the implementation of a new laboratory workflow process. The improvement process included relocating the specimen registration site, laboratory notification before specimen arrival, a color-coding system on tubes, timing at all processes, and eliminating the smear review if platelets were normal. TATs of the laboratory and door-to–clinical intervention times before and after the improvement process were compared.
Postintervention, median specimen transportation time decreased from 11 (interquartile range [IQR], 8.4–16.4) to 9 minutes (IQR, 6.3–12.8), P < .001. The intralaboratory and total TATs of complete blood cell count, coagulation tests, and creatinine significantly decreased (P < .001 all). Blood drawn–to-laboratory reported time decreased from 43 (IQR, 36.0–51.5) to 33 minutes (IQR, 29.2–35.8, P < .001). However, door-to-needle time for thrombolysis and door-to-puncture time and door-to-recanalization time for mechanical thrombectomy were not statistically different (P = .11, .69, and .50, respectively).
The new laboratory workflow significantly decreased transportation time, TAT of individual tests, and the blood drawn–to-laboratory reported time. However, the time to treatment of acute ischemic stroke patients was not different between preimplementation and postimplementation.
Author notes
The authors have no relevant financial interest in the products or companies described in this article.
Competing Interests
Reesukumal and Pratumvinit each received a Chalermprakiat Grant from the Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand. The funding organization played no role in the study design; the collection, analysis, and interpretation of data; the writing of the report; or the decision to submit this report for publication.
