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.

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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.