Turnaround Time and Staffing Standards

Kelly,

Staffing Standards:  Each facility has unique needs.  Published staffing guidelines are difficult to apply since there are so many variables.  Examples:  how many manual entry processes do you have?  Age of instrumentation which affects maintenance, troubleshooting, etc?  Are staff cross trained across multiple disciplines as generalists or are staff specialized?  How robust is your transfusion service and are they automated or still on manual testing?  Is phlebotomy centralized or decentralized?  How prone to FMLA leave are your staff?  In a previous life I expected to have 8 hours of sick leave daily.  Where I am at now, we average about 16 hours of sick leave a month with a staff of 15 FTE.  Work ethic is an intangible attribute.

Turnaround time standards:  have so many ways to be compared, but there really is no truly "formal' recommendation since there are so many variables that either can or cannot be controlled.  Even comparing TATs between multiple facilities within one organization can be difficult due to test volume variations.  Do you want to look at individual tests i.e. the tat for a CBC, CMP, CRP, etc or do you want to look at an aggregated average, where perhaps you may want to target for a 20 minute average or less?  Does one facility mainly deal with "normal" patients for whom you are performing annual testing, or do you have a high population of "sick" patients that affects repeat testing to verify abnormal results?

Are you more concerned about "perceived" TATs by clinicians which begins from the time they say "I want this and that testing" to the nurse, or "from receipt in lab to result out the door".  We measure CBC's, CMP's, BMP's, bilirubins as our core tests and we average 15-18 minutes each month based upon our ratios of test volumes.  Another institution measuring the same four tests may average 20 minutes  or more because they perform a disproportionately higher volume of chemistry tests that take longer.

I would start with pulling historical data in order to set a baseline.  Focus on the meaningful tests to your patient population or the key services in your facility (ED, ICU, etc) where TAT means something.  The Ortho unit may not care about a PT result being back in 15 minutes.  They may be fine with 2 hours. 

What lean principles does your facility utilize, if any?  If you aren't familiar with lean principles related to lab efficiencies, do some research and try to learn about them and determine what processes that don't cost any money can be used to improve specimen flow.  One piece flow is a great process that makes sense once you understand it.  Use of STAT spin centrifuges that can shorten centrifugation times to 3 minutes in conjunction with single piece flow compounds savings.

Call me, I would be happy to talk all day about staffing and TAT's.

402-778-6055

Thank you for your reply.

Unfortunately in regards to turn around time, we will always be fighting the "perceived" notion of what physicians and nursing staff feel should be obtainable and what is realistic. I was hoping to get sometime type of regulatory documentation, to help address the cause. As I am sure you know physicians often only respond to written information or information delivered by other physicians.

Our current turnaround times were set by former management staff and do not reflect current staffing conditions, instrumentation or workflow. Currently we use metrics that in my opinion are not well defined. The statistical information is often gathered based on test priority and not unit or location. This is what I am looking to change.

We are currently using "One Piece Flow" in our ER but have failed to implement the process for the rest of our inpatient locations. These locations tend to use batch processes.

Would you mind telling me what type of information you collect for QA monitoring for turn around times? Do you have the data separated by test, order priority, ordering location, or a combination of the three? Any information that you are willing to share would be greatly appreciated.

Thanks Again,

Kelly

Let's take this discussion off-list.

Send me an e-mail directly to my work e-mail and we can converse that way.

Gregory.olsen@boystown.org