“The Right Test on the Right Patient at the Right Time”…how often have you seen or heard this mantra?  It’s a goal all laboratory professionals should have!  The Institute of Medicine (IOM) lists ‘timeliness’ as one of the six Quality Aims1: “reducing waits and sometimes harmful delays for both those who receive and those who give care”.

Laboratory professionals have historically viewed time in terms of turnaround time (TAT), usually with the stopwatch starting when the specimen enters the laboratory and stopping when the result is made available for a clinician to review.  Laboratory professionals are fantastic about keeping ‘traditional’ TAT very short.  But to truly respond to the IOM’s charge, and to truly provide the best care possible to patients, laboratory professionals need to think outside the 4 walls of the lab, and consider the total testing process (TTP)2.

The TTP has also been coined the ‘brain-to-brain’ loop (the brain belonging to the clinician), beginning with the original clinical question that leads to the ordering of a laboratory test, and ending with interpretation of the test result and a decision about the patient’s care.  The interfacing of laboratory professionals with the clinician on the front and tail end of this loop is quite error-prone.  Inappropriate test requests, delayed reaction to abnormal results, incorrect interpretation of results, and inappropriate follow-up plans are all examples of errors that occur at these interfaces, and are believed to account for nearly 75% of errors in the TTP3.

Laboratory professionals need to reconsider their measurement of turnaround time to include the TTP.  By helping clinicians make good decisions about what tests to order and when, and by providing interpretative services when the result is ready, labs can play an active role in reducing delays in diagnosis and treatment.

 

1Committee on Quality of Healthcare in America. Institute of Medicine. Crossing the quality chasm: a new health system for the 21st century. Washington, D.C.: National Academy Press; 2001.

2Westgard, JO, Westgard, S. Clinics in Laboratory Medicine: Quality Control in the Age of Risk Management. March 2013. Vol 33. No 1.

3Plebani, M. The detection and prevention of errors in laboratory medicine. Ann Clin Biochem 2010; 47:101-10.