IMPROVING EMERGENCY DEPARTMENT (ED)

POTASSIUM TURNAROUND TIME (TAT)

CONTEXT
Location : Emergency Department Laboratory – Central Military Laboratory & Blood Bank
Hospital : Prince Sultan Military Medical City, Riyadh, Saudi Arabia (1,200-bed acute care tertiary teaching hospital)
Sponsor : Director of Central Military Laboratory & Blood Bank

FOCUS PDCA
PROBLEM STATEMENT

Delivering results in a timely manner ensures good quality patient care, better utilization of
the Emergency Department operation and reduce the cost of unnecessary complications pa-

F tients may develop due to delay in care and increase the length of stay. Consequently, stat
tests TAT is considered one of the most significant performance measurement of any medi-
cal laboratory. Not meeting established benchmark compared to national accredited insti-
What:
Actions, Recommendations, Tasks
Who:
Responsible Staff
How: When:
Due Date
Status
Update/Notes

tutes for ED potassium turnaround time (TAT) within 60 minutes. The goal of this project is Separate (K) from the rest of the general Monitored by ED Lab
1 ED Lab Supervisor Auto-verification Dec 2013
to identify opportunities to improve and help meet the established ED Potassium turna- profile Supervisor
round time.

GOALS Increase awareness of (K+) (TAT) for pa- Nursing Included in orientation for
2 By posters Dec 2013
tient safety Nursing Education Unit new nurses.
To deliver potassium (K+) results to ED physicians and nurses within 60 minutes on time, all
shifts, every time.  Power Point Presentation
showing tubes samples
1 month to be repeated as

O
Porter Supervisor and requirements
STAFF Laboratory: Supervisor Emergency Department Laboratory & Quality Specialist 3 Increase ED porters’ efficiency/education
Lab Supervisor  Posters highlighting speci-
Dec 2013 needed and will be part of
Emergency Department: Emergency Department Physician, Nursing & Portering staff annual competency
TEAM men transportation & han-
Continuous Quality Improvement: Facilitator dling
 Review the centrifuge
 Central Military Lab specifications and order Expected
4 Buy Stat Centrifuge  Bioengineering Follow the purchasing ap- Received April 2014

May 2014
 Supply & Purchasing proved process

Dedicated phlebotomist for blood collec-

5
tion. Staffing plan submitted to

C
6 Human Resource Dept.
Increase staff (lab technicians & nurses) HRD February 2014
7
Dedicated porters for specimen transport.

Develop Standard Operating Procedure Follow laboratory guidelines  Laboratory staff acknowl-
ED Lab Supervisor with
8 (SOP) for specimen collection & to Feb 2014 edgment of SOP
input from nursing.
transport. develop SOP  Nursing orientation

CURRENT SITUATION
All reported potassium results from ED Laboratory were retrieved using the available data from LIS
then analyzed
= % ED K with
NUMERATOR (K reported within 60 min) TAT within 60 min
DENOMINATOR (All K results reported)

a. Explore entire specimen testing phases

b. Identify opportunities for improvement
c. Plan for root cause analysis
d. Improving ED potassium TAT reporting

RECOMMENDATIONS

U Implemented in January 2014

1. Auto-verification of K+ results as per laboratory policy.

2. An awareness of the importance of K TAT poster was distributed by the laboratory and hospital
CQI&PS to ED Nursing.
3. Increase ED porters efficiency
4. Additional centrifuges (stat centrifuge) – Installed in ED Lab in April 2014

CONCLUSION

Laboratories performance and quality is judged by their ability to have critical and urgent results available for
caregivers when needed to better manage patients’ care. At the time of this project, the ED Potassium TAT was

S Using prioritizing methods to identify the root causes and solutions that we plan to tackle

1.
2.
3.
Buy stat centrifuge
Maintain enough supply (lab request form, gloves, alcohol swab, tubes, etc.)
Increase staff (laboratory technicians and nurses)
inconsistent and at a distance away from meeting the established TAT of 60 minutes or less. This has triggered
for a comprehensive analysis of the entire testing process through observation, reviewing available data, value
stream mapping, identifying improvement opportunities and eliminate waste. Causes for the prolonged
TAT identified include inefficient sample delivery, lack of awareness of the importance of such results, im-
4. Increase area of laboratory to occupy extra machine (upgrading laboratory) proper tests grouping and not fully utilization of available technology. Out of these causes, improvement oppor-
5. Separate (K) from the rest of the general profile. tunities were identified and the proper resolutions such as training and education, separation of tests , auto veri-
6. Dedicate porters for specimen transportation
7. Dedicate phlebotomists for blood collection to free nurses to do their work.
fication and stat centrifuges were implemented. As a result, the TAT went from mid 60% to almost 100%. The
8. Increase awareness of (K) (TAT) for patient safety (nursing). real impact of this project not only the great improvement it made to the ED Potassium TAT, but it also high-
9. Laboratory Information System / Hospital Information System (LIS/HIS) is old and do not support clinical order en- lighted the importance of TAT in general and will prompt for more projects to improve the overall quality of
try – Need to upgrade health care being rendered to the patients.
10. Porter Education
11. Develop Standard Operating Procedure (SOP) for specimen collection and transportation for ED Laboratory.  Regular review – monthly – of performance measures – TAT- looking for unacceptable
performance and trends.
PRIORITIZATION MATRIX  Regular review of performance goals whenever systems, workflow or equipment change
and on an annual basis
High 7, 9 8, 10 1, 5
 Supplementation of internal TAT monitoring with enrollment in external program such
CAP Q-Track.
Medium 4 6, 3 11
Effective

REFERENCES:
1. Fernandes C.M.B., Worster A., Hill S., McCallum C., Eva K., Root Cause Analysis of Laboratory Turnaround Times for Patients in the Emergency De-
Low 2 partment. Can J Emerg Med 2004; 6 (2): 116-122
2. Blick K E, Providing Critical Laboratory Results on Time, Every Time to Help Reduce Emergency Department Length of Stay. Am J Clin Pathol.
Low Medium High 2013; 140 (2): 193-202
3. Hawkins R, Managing the Pre- and Post-Analytical Phases of the Total Testing Process. Ann Lab Med 2012; 32: 5-16
4. Howanitz PJ, Cembrowski GS, Steindel SJ, Long TA. Physician Goals and Laboratory Test Turnaround Times. A College of American Pathologists Q
-Probes Study of 2763 Clinicians and 722 Institutions. Arch Pathol Lab Med 1993; 117: 22-8
Achievable 5. Steindel SJ, Novis DA. Using Outliner Events to Monitor Test Turnaround Time. Arch Pathol Lab Med 1999; 123: 604-14
6. Hawkins RC, Laboratory Turnaround Time Clin Biochem Rev 2007; 28: 179-194