STAT Type and Screen Turnaround Times (Survey)

[goodchild]

There have been several discussions/surveys about this subject in the past but the most recent was two years old and I'd like to revisit it with more current information. I'm finding that with the ProVue analyzer (for us) it is fairly difficult to meet a turnaround time of 60 minutes consistently (90+%). I really wanted to see how things were for the rest of the bloodbanktalk community.

 

("you" refers to your institution)

 

1. What kind of hospital are you and what size? (Community, university, teaching, etc. Small, medium, large, or number of beds, etc) Any add'l info you'd be willing to provide to give an idea of the workload would be appreciated, approx. type and screens tested, rbc units transfused, etc.

 

2. What is the established turnaround time for your STAT type and screens? Do you have any location specific criteria?

 

3. What are the parameters for your turnaround time? (i.e. receipt to verify, collect to verify, is the specimen received by your department or a centralized specimen processing area? is the specimen received already spun or do you spin them upon receipt?)

 

4. What is the primary method for your Type and Screen testing?

 

5. Do you monitor your turnaround time as a quality indicator and with what regularity? If so, do you think this is an appropriate quality indicator? How do you report this information? (e.g. do you report a time at a particular percentile, do you report the percentage of specimens that met a particular turnaround time?)

 

For anyone who answers, I greatly appreciate your time!

 

 

[goodchild]

1. Community teaching hospital 250+beds. 1000+ specimens/month. 400+ units txd/month.

 

2. 60 minutes.

 

3. Receipt to verify. Shows up unspun and 80% of the time directly to transfusion service, the rest get received through specimen processing department.

 

4. Ortho ProVue.

 

5. Not with any regularity, but going forward yes. I personally think this is an important issue to look at but there's a lot of resistance that turnaround time shouldn't be a quality indicator for a transfusion service. I'm debating of reporting out the percentage of specimens that reach a specific turnaround time cutoff or the turnaround time for the specimen at the 90th percentile.

[SMILLER]

There have been several discussions/surveys about this subject in the past but the most recent was two years old and I'd like to revisit it with more current information. I'm finding that with the ProVue analyzer (for us) it is fairly difficult to meet a turnaround time of 60 minutes consistently (90+%). I really wanted to see how things were for the rest of the bloodbanktalk community.

 

("you" refers to your institution)

 

1. What kind of hospital are you and what size? (Community, university, teaching, etc. Small, medium, large, or number of beds, etc) Any add'l info you'd be willing to provide to give an idea of the workload would be appreciated, approx. type and screens tested, rbc units transfused, etc.

 

2. What is the established turnaround time for your STAT type and screens? Do you have any location specific criteria?

 

3. What are the parameters for your turnaround time? (i.e. receipt to verify, collect to verify, is the specimen received by your department or a centralized specimen processing area? is the specimen received already spun or do you spin them upon receipt?)

 

4. What is the primary method for your Type and Screen testing?

 

5. Do you monitor your turnaround time as a quality indicator and with what regularity? If so, do you think this is an appropriate quality indicator? How do you report this information? (e.g. do you report a time at a particular percentile, do you report the percentage of specimens that met a particular turnaround time?)

 

For anyone who answers, I greatly appreciate your time!

 1. We are a 270 bed community hospital, level 2 trauma center, with a CA treatment center and neuro unit along with ortho nad other med-surg patients.  No OB or peds.  In general , for BB we staff 2-3 techs on days M-F, 1 on nights and weekends.

 

2. One hour for STAT T&Ss, but in general, these are finished a bit more quickly (uncomplicated ones anyway) as long as we get the specimen STAT.

 

3. Specimens are spun on receipt.  We monitor all phases from collection to final test result.  All BB specimens here are drawn by Lab phlebots, except for pre-op patients.

 

4. Manual gel, tube for ABO/Rh.

 

5. At this time we are not reporting TATs.

 

Scott

[David Saikin]

1. 40 bed community hosp with oncology, level 3 trauma, active ED/OR/Ortho.  Transfuse about 500 rbc/yr

 

2.  Our goal is 60 minutes, usually  resulted in 50.

 

3.  Timed from receipt to release.

 

4.  Manual gel for everything but can do tube ABORh for unxm release.

 

5.  Lab Mgr occasionally monitors this test . . .  rarely falls out.

[Justina]

1. Community, 300 bed. Transfuse about 450 units/month. No OB or Ped.

 

2. Stat TAT for a T&S is 45 mins (not location specific).

 

3. Parameters: Receipt in BB to verified ABSc.  All samples are tubed to the Central Processing Dept., who then delivers it to the BB. Spin upon receipt.

 

4. Primary method: ABO/Rh-manual tube, ABSc-manual gel.

 

5. TATs are monitored daily. Downside:  a sample can "sit" in the dept and still meet TAT since the time doesn't start until it is logged in LIS (although this rarely happens). We also use it to monitor if Standard Work is being followed (ie. TAT's should not be less than 25 mins). We have a report that generates daily and it gives use a percentage of samples meeting TATs for Stats and Routines. 

[goodchild]

Thanks Scott, David and Justina. I run into the same situation Justina and that's one of the things I plan on looking at. I'm already seeing several dozen type and screens where the turnaround time is 0-1 minutes.

 

This isn't ideal, specifically when specimen receipt is where we would determine whether a patient has a previous history or not and if they need a Retype, it would be reflexed. Not receiving the specimen initially could delay crossmatch compatible blood.

 

Anyone willing to post any info for an institution that utilizes automation?

[AMcCord]

There have been several discussions/surveys about this subject in the past but the most recent was two years old and I'd like to revisit it with more current information. I'm finding that with the ProVue analyzer (for us) it is fairly difficult to meet a turnaround time of 60 minutes consistently (90+%). I really wanted to see how things were for the rest of the bloodbanktalk community.

 

("you" refers to your institution)

 

1. What kind of hospital are you and what size? (Community, university, teaching, etc. Small, medium, large, or number of beds, etc) Any add'l info you'd be willing to provide to give an idea of the workload would be appreciated, approx. type and screens tested, rbc units transfused, etc.

 

2. What is the established turnaround time for your STAT type and screens? Do you have any location specific criteria?

 

3. What are the parameters for your turnaround time? (i.e. receipt to verify, collect to verify, is the specimen received by your department or a centralized specimen processing area? is the specimen received already spun or do you spin them upon receipt?)

 

4. What is the primary method for your Type and Screen testing?

 

5. Do you monitor your turnaround time as a quality indicator and with what regularity? If so, do you think this is an appropriate quality indicator? How do you report this information? (e.g. do you report a time at a particular percentile, do you report the percentage of specimens that met a particular turnaround time?)

 

For anyone who answers, I greatly appreciate your time!

1.  Community hospital with 140 beds. Active heme/oncology service, general surgery, orthopedic surgery, OB/Gyn, general medicine. Level 3 trauma. Transfuse approx 100 units RC-LR per month. We do approx 250 T&S each month plus prenatal panels.

 

2 & 3. Our STAT turnaround time for T&S is generous. We started out working for 90 minutes from time of receipt, which we now hit >95% of the time - avg time is 52 minutes. I've started turning the screws on that. Last year we started working on turning T&S around in 90 minutes from time of order. It's do-able, though we've found that most of our outliers are due to phlelobotomy times (phlebs draw all lab work). We receive our specimens unspun. The locations included are all inpatients, ER and Surgical Service. Problem patients (antibodies, patient not available for draw because he/she is in X-ray, etc) are excluded.

 

4. Primary method is the Echo. Our second type is done by tube, usually while the Echo is running the T&S. I don't differentiate between new patients and patients with history for data collection.

 

5. I monitor all STAT turnaround times (no I'm not a full time paper mover, I work the bench a lot and yes, it's difficult to find enough time). I do not have a blood bank information system, but Blood Bank orders come through our LIS and are reported through home-grown report forms via the LIS. That makes it possible for me to run turn around time reports through the LIS. We have the time for final report set at 90 minutes, so all outliers print - saves me a ton of time.

I analyze for shift and test time (to final report). The phlebs have 15 minutes from time of order to get the specimen draw - I look at collection time as well as receipt time. I report out percentage of tests that hit the mark and average turnaround time for all shifts, which is a more positive way to look at the data than percentage that miss. I put the data on a graph - easy for everybody to see how we are doing.  I look to see if a particular person is having problems. If so, I work with that person to see what we can do to improve their TATs. (I had a night tech who simply lost track of time, so I asked her to carry a timer in her pocket set for the end time on the Echo. Problem solved - TATs improved several %.)

This is part of my quality report.

Edited June 20, 2013 by AMcCord

[goodchild]

Just out of curiousity, McCord, when you say second type done by hand do you mean a second specimen to confirm or are you retyping the initial type and screen? We have a similar process, all of our "Retype" specimens are supposed to be performed by manual tube method but I know a bunch of them end up on the ProVue.

 

I do like your idea of looking at percentage of specimens complete.

 

 

I forgot to include in the survery whether your technologists on any shift are generalists or blood bank techs only.

[Townsend]

1. Free-standing pediatric hospital.  Level one trauma center with approx 425 beds.  We do approx 500 samples per and about 1,000 products per month. All surgeries and transplants except liver transplants currently.

 

2. Published STAT Type and Screen is within 60 minutes.

 

3. Receipt to resulting of the antibody screen.  We spin sample after receiving it.  Most samples are received in central processing, but some come to us directly.

 

4. Manual gel for everything except blood type which is still tube method.

 

5. TAT is monitored as part of a QA monitor for Emergency Room samples only.  Target is at least 95% within 45 minutes of receipt.  So far for 2013 average is around 97%.  Historically probably averaged in the low 90s.

 

Stephanie Townsend, MT(ASCP)SBB

[SportsFan]

1. University hospital with ~560 beds. Average number of samples per month is 2,400 and avg. # of RBCs transfused per month is 2,000.

 

2. STAT is 60 minutes and often from OR, ER, or L&D.

 

3. Logged in to blood bank to verify results. Most come directly to the blood bank and we spin it.

 

4. Neo or sometimes the Echo

 

5. Yes, monthly by our lab QA manager. Both STAT and regular type and screens are monitored. TAT starts when the specimen is logged into the blood bank system not when it arrives so a sample could be in the blood bank but not logged in (happens more with non-STATs for batching purposes).

[AMcCord]

Just out of curiousity, McCord, when you say second type done by hand do you mean a second specimen to confirm or are you retyping the initial type and screen? We have a similar process, all of our "Retype" specimens are supposed to be performed by manual tube method but I know a bunch of them end up on the ProVue.

 

I do like your idea of looking at percentage of specimens complete.

 

 

I forgot to include in the survery whether your technologists on any shift are generalists or blood bank techs only.

 

Our 2nd type is done on the initial type and screen specimen (management decision). Our retype rule is 2 methods (Echo + tube) or by 2 techs (generally on cord blood specimens, pediatric specimens or trauma cases). I enforce that strictly ... cause it is human nature to want to want to fudge  .

 

I am the only dedicated blood banker ... everybody else is a generalist, though I do have 2 generalists who average 2 days a week in blood bank and perform very well.

[tbostock]

 

There have been several discussions/surveys about this subject in the past but the most recent was two years old and I'd like to revisit it with more current information. I'm finding that with the ProVue analyzer (for us) it is fairly difficult to meet a turnaround time of 60 minutes consistently (90+%). I really wanted to see how things were for the rest of the bloodbanktalk community.

 

("you" refers to your institution)

 

1. What kind of hospital are you and what size? (Community, university, teaching, etc. Small, medium, large, or number of beds, etc) Any add'l info you'd be willing to provide to give an idea of the workload would be appreciated, approx. type and screens tested, rbc units transfused, etc.

 

2. What is the established turnaround time for your STAT type and screens? Do you have any location specific criteria?

 

3. What are the parameters for your turnaround time? (i.e. receipt to verify, collect to verify, is the specimen received by your department or a centralized specimen processing area? is the specimen received already spun or do you spin them upon receipt?)

 

4. What is the primary method for your Type and Screen testing?

 

5. Do you monitor your turnaround time as a quality indicator and with what regularity? If so, do you think this is an appropriate quality indicator? How do you report this information? (e.g. do you report a time at a particular percentile, do you report the percentage of specimens that met a particular turnaround time?)

 

For anyone who answers, I greatly appreciate your time!

 

1. Community hospital (soon to be teaching hospital), somewhere around 350 beds. We do about 40-50 type and screens per day. We have OB/NICU, we are a trauma center (level II).

2. 60 min TAT for stat TS (Type and Screens) (most of ours, except maybe PST samples, are ordered STAT).

3. Receipt to verify. We try to get as many TS delivered directly to BB so we can receive them and spin them (we use a Stat Spin centrifuge to keep that down to 3 minutes).

4. Our primary method is solid phase (automation: Tango). Takes approx 45 mins unless there are a lot of samples already running. If a patient is actively bleeding or a trauma, we'll do it on the bench in gel (30 minute TAT).

5. We do not monitor our TAT yet for TS but have the ability to. Yes, I do think this is a good quality indicator.

We do get frequent complaints about our TAT, but we almost always find out the delay was getting the specimen from the bedside to our Blood Bank.

[goodchild]

Thanks Townsend, Sportsfan, and Terri.

 

Are there any Ortho ProVue institutions out there who would be willing to share your input?  If you'd rather not post anything publicly, I'm happy to receive a PM from this page or provide my personal e-mail.

 

Thanks!!

[kate murphy]

1. University hospital ~ 500 beds. Full range of service - level 1 trauma, cancer care, L/D, peds, NICU.  Ave 1500 specs/mo and 1000 rbc/mo.  Separate ABO confirmation spec required on all new patients - BB orders upon receipt of 1st spec, sends unique tube for this draw.  Use electronic XM for most patients.

 

2. Stated Stat TAT is 60 minutes. 

 

3.  TAT from collect to results. Specs delivered to BB usually by p-tube, BB spins. 

 

4.  Primary method is Galileo, but stats usually done manual PeG tube.

 

5. No longer monitor TAT - difficult to do as specs are good for 3 days.  Lab computer system TAT counts every new Xm as a new results, so TAT are unrealistically skewed.  Hard to get the initially Type/Screen TAT.

[goodchild]

Kate, what LIS system do you use? I ran into this problem when I initially tackled the concept of T&S turnaround time. Our report pulled a time for each element of the T&S result entry field.

 

After fooling around with some settings I was able to set up the report to pull only the time that the antibody screen was resulted. I was also able to hone in on the "ProVue Blood Type" result field, so I can identify which specimens were resulted via ProVue interface and which ones were done manually or done on the ProVue but keyed in. We use Meditech 5.65.

 

Thanks for your post as well. Does anyone else on BBT even use the ProVue?

[jill]

We have a 1 hr TAT on STAT T&S.  We usually meet that

time frame because the ECHO takes 22 minutes to complete

the test.  We have to edit the sample in the computer and

manually enter in results.  This adds on another 5 minutes to the

testing time.

[OxyApos]

Like the rest of you, our barrier is the draw time frame.  Once in the dept, spinning + Echo + Computer can be as little as 40 min.  A few extra minutes either way for electronic XM or an initial spin.  Once Echo gives type, @ 12 min into process, I can try to obtain a specimen from Hemo for a type recheck if they're non O. 

 

300 bed hospital/ @ 600 Type/ screens/ month

 

We don't gather information for quality per se because most of our specimens are pre admits or routines that we aren't trying to run in a speedy fashion. Our LIS shows the H/H while in the TYSC results entry area so we can see if its critical.  When there has been a need for investigation of blood delays, it is always the specimen collection piece that is the problem. 

[kate murphy]

Hi goodchild, we use Sunquest.  In the past, we've look at TAT for the ED only.  Identify yesterday's specs, then look them up individually in Sunquest to see when that first ABO and screen result was done.  Time consuming, but realistic for the location that really needs a Stat TAT.  We found about 40 minutes for these specs.  The ED is satisfied with the TAT, so it was just a baseline.  I'll only look at it again if there is a problem or a complaint of a delay.

Complaints of delay in the past usually involved a patient with an antibody.  The trauma docs have a healthy respect for antibodies!

[LCoronado]

We are a community hospital with 110 beds. 

We use tube method for ABO/Rh and manual gel for screens with tube method as backup. 

All of our techs are generalists who rotate through all departments. 

Our goal for  STAT TAT is one hour from receipt to verify but it is not currently monitored. 

 

It can be very difficult to fulfill this goal when there is only one tech in the Blood Bank or, on off-shifts, only 1 or 2 for the entire lab; we have a fairly active Emergency Department, OB, ICCU and OR which can and have all needed services at once. The ED believes their patients should take precedence regardless of the circumstances but these are not always the most emergent in reality.

 

Also, I'm sure all of you run into the overuse of the word "STAT" so that it is sometimes difficult to determine the true nature of those needs and to prioritize the work when you are alone or in scant company during an off-shift. 

[Sandy L]

Thanks Townsend, Sportsfan, and Terri.

 

Are there any Ortho ProVue institutions out there who would be willing to share your input?  If you'd rather not post anything publicly, I'm happy to receive a PM from this page or provide my personal e-mail.

 

Thanks!!

 

1. Community Hospital 500+ beds with active trauma, transplant, large OB service, 800 deliveries/month plus 75 bed NICU.  We transfuse ~1000 RBC/month.  We perform  1800 ABO/Rh, 1000 Antibody screens, 1400 Electonic Crossmatches, 200 serologic extended crossmatches per month.

 

2. Stat TAT is published at 60 minutes.

 

3. Receipt to verify. Blood Bank spins samples upon receipt

 

4. Primary method: ProVue (2 insturments).  Backup manual tube ABO/Rh and Gel ABSC.  We try to do as much testing as possible on ProVue but even with 2 instruments, they get backed up with routine testing and slow down the STAT’s.

 

5. TAT is very difficult to monitor in our LIS.  We cannot monitor for Corssmatch as samples stay “open” for 3 days (pre-op up to 10 days).  The best we can do is monitor STAT antibody screen as a marker for the Type and Screen TAT, and even that is very difficult to do without a lot of manual data mining.  We do not regularly monitor, but we know we miss our 60 minute TAT due to the issues mentioned in #4.

[goodchild]

Thank you for posting Sandy! Your experience is similar to our own.

 

The ProVue is advertised as a "continuous throughput" device but I think that's a bit of a stretch of the imagination. I suppose once one batch of specimens is done identifying, diluting and pipetting you can hit the emergency stop button and add more specimens, but in our experience there's a higher and higher likelihood of a system crash with each emergency stop, we've never been able to do a fourth emergency stop in a row without a crash. The crash kills the main provue software and all in-process testing is now worthless and has to be manually removed from their locations, discarded and restarted by hand or on the analyzer.

 

Out of curiousity, did you go live with both analyzers at once or did you get them one at a time?

[Sandy L]

Thank you for posting Sandy! Your experience is similar to our own.

 

The ProVue is advertised as a "continuous throughput" device but I think that's a bit of a stretch of the imagination. I suppose once one batch of specimens is done identifying, diluting and pipetting you can hit the emergency stop button and add more specimens, but in our experience there's a higher and higher likelihood of a system crash with each emergency stop, we've never been able to do a fourth emergency stop in a row without a crash. The crash kills the main provue software and all in-process testing is now worthless and has to be manually removed from their locations, discarded and restarted by hand or on the analyzer.

 

Out of curiousity, did you go live with both analyzers at once or did you get them one at a time?

We went live with one instrument in 2005 and added the 2nd in 2011.  Our workload had increased substantially between '05 and 2011.  We were constantly emergency stopping to add samples as soon as the previous batch had finished pipetting.  With only one instrument we were forced to do quite a bit of our STAT workload manually.  We still do emergency stop and add samples but are able to accomodate most of our STAT as well as routine workload on the instruments.  We are looking forward to the replacement for ProVue.

[Dansket]

_{1. Currently in a small facility with an average census of <50 patients.  Active, ER, OB and Surgery. Average of 74 Type and Screens monthly. Transfuse 100-120 RBC monthly.}

 

_{2. Our goal of 70 minutes is met 80-85% of the time.}

 

_{3. Receipt to Verify.  Samples are delivered directly to Blood Bank unspun.  Centrifuge for 3 minutes with Statspin.}

 

_{4. Two (2) ProVues, no manual testing (tube or gel) is done.}

 

_{5. We are using Meditech 5.64 going to 5.66.  Have a custom NPR report to download data and then sort in Excel.}

 

_{6.  We have similar situation as LCoronado as a barrier to reducing TAT}

[goodchild]

Thanks Dansket.

 

Are there any other individuals willing to share their information? I can't have too many respondents!

[ChrisH]

1. Community, between 140 and 300 pending what time of the year it is. We do about 500 crossmatches a month.  Plt - 70, FFP 120, RBC 400

 

2.TAT 60 minutes, from collection to completion  Do you have any location specific criteria? NO

 

3. see above

 

4. Gel ABS, Tube ABO

 

5.  Yes we do use it as QA Monthly indicator