I previously asked all of you when your clock starts for the 4-hour transfusion time. Now I have a different clock to ask about.

When does the clock start for your Turnaround Times (i.e. STAT, ASAP, Thawed Products, etc): From the time the Physician places an order in the interfaced computer (so still needs specimen drawn) or, from the time the specimen arrives in the Blood Bank? Having a little disagreement on this issue at my current job.

Thanks,

Brenda Hutson, CLS(ASCP)SBB:)

We go from the time drawn

From time of receipt in the Lab.

Time received in the department. We can't control the preanalytical part. (we can yell, but that just slows it down)

From the time it is received in the Transfusion Department. To do otherwise would require an average of all other factors to give a realistic turn around time.

We go from the time drawn

Since phlebotomy is the unknown in this process, I am wondering then, what is the process by which you receive the specimens? Are they delivered by hand? By Pneumatic Tube? Etc. Have you found that you receive them in a timely manner from the time drawn? And on another note, if you know this, how efficient is "their" TAT from the time the Order is placed untilt he time the blood is drawn?

Thanks,

Brenda Hutson, CLS(ASCP)SBB

The last place I worked, we could track the times of "order placed," time drawn, and time rec'd in lab. Anytime a group wanted to talk "turnaround times" I always insisted we talk all the times. As Karen states, we (lab) can't control the times before specimen hit the lab, but neither can they control the lab times. Our lab turnaround times were always shorter than the nursing times and anytime nursing stated that they could not change anything, we stated the same. By the way, we had Meditech C/S which has standard reports showing all these times.

When I look at turn around time, I look at time received in the department. Our software can look at several different times, so if we want to address the order to receive or collect to receive, we can.

Our Lab is responsible for the Turn-Around-Time (TAT) from the time ordered until the time the testing is finished. When our Lab administration wants to evaluate TATs or investigate TAT problems, they break it down the two factors: The collection TAT (time ordered until time delivered to Blood Bank) and the Blood Bank TAT (time received in BB until time the testing is finished (so that they can address the specific area that needs improvement.) (Our Lab computer can generate these various time frames.)

We receive our samples by both hand delivery and via pneumatic tube. Sometimes we receive samples in a timely manner; often times we do not. The collection time is sometimes good; often times it is not. It mainly depends on how heave the phlebotomy workload is and how the phlebotomy staffing level is (and of course, how many people have called in "sick" that day!!) Right now we have had several phlebotomists resign or retire, and hospital administration will not let us replace the positions.......so even though we have a lot of good people on staff, there are limits to how much or how fast they can perform their work.

Now I'm going to make you all envious!

For routine Reference Work, we have a target TAT of 95% by 5 working days (that's Monday to Friday). This gives us so much more scope than people working in the hospital environment. The difference is, of course, that the samples we receive are the ones that the Hospital Blood Banks cannot work out themselves (or, at least, that's the samples we are supposed to receive)!

This is not, I stress, because the workers in the hospital environment are any less skilled or knowledgable than my colleagues and me, but simply because we have access to many more reagent red cells and antisera.

Of course, if the sample is urgent, we have a much tighter TAT, but this TAT starts when the sample actually reaches the Laboratory, but the TAT is still probably longer (a matter of several hours) than most hospital's TATs, bacause of the nature of the work.

I think the record for an urgent with a nasty antibody is 2 hours for a patient with anti-Era+K, who was bleeding on the table ("cold" operation, taken to theatre with no blood cover, despite a high risk of bleeding), and that includes the cross-match. To put it in context, it was the first case of anti-Era found in England!

:D:D

Although we use use receipt-in-lab to start our stat TAT, I say choose something to measure that will provide meaningful feedback for your site and consistently try to meet it.

If your facility's phlebotomy team is lab-controlled, order-to-verify may be an appropriate process measure. But if you rely on nurses to draw and transport, then receipt could start the timer, since they are notoriously lax on lab-related activities.

I've heard it said that the clinician's personal TAT starts when he/she THINKS about ordering the test ...

All right Malcolm, rub it in!!! Just out of curiosity, how many phone calls do you get from the client hospital while you are attempting a "stat" workup? We act as a reference lab for the clients of our blood center (we are definitely not an IRL...the anti-Era + K would have gone right back out the door). We get many patients with warm autos and underlying allos from tiny hospitals around our area. Somehow they do not understand the time it takes to get these workups done (while we are crossmatching, doing components, and issuing for emergency cases, open heart surgeries, etc. with no extra staff), and they seem to think that we won't let them know when we get it done (or that we will do it faster if they keep bugging us). Any advice on handling the customer service end of the equation? Also, what is a reasonable turn around time for a workup that is more than one or two simple antibodies?

All right Malcolm, rub it in!!! Just out of curiosity, how many phone calls do you get from the client hospital while you are attempting a "stat" workup? We act as a reference lab for the clients of our blood center (we are definitely not an IRL...the anti-Era + K would have gone right back out the door). We get many patients with warm autos and underlying allos from tiny hospitals around our area. Somehow they do not understand the time it takes to get these workups done (while we are crossmatching, doing components, and issuing for emergency cases, open heart surgeries, etc. with no extra staff), and they seem to think that we won't let them know when we get it done (or that we will do it faster if they keep bugging us). Any advice on handling the customer service end of the equation? Also, what is a reasonable turn around time for a workup that is more than one or two simple antibodies?

Hi adiescast,

We sometimes get one telephone call when we are doing a STAT workup. During this telephone call, the caller is reminded why they sant the sample to us in the first place and also reminded (as you say) that we cannot complete the work whilst we are on the telephone. If asked how long we will be, we often ask them how long is a piece of string, on the grounds that, until we have completed the work, we do not know whether we will be able to supply compatible blood, or have to get some in from the National frozen Blood Bank. They rarely telephone a second time!

On the other hand, in case this sounds too harsh, we always telephone the hospital if we think that the work will take more than about 4 hours (including differential adsorption), so we do keep them informed at all times.

In answer to your last point, I'm afriad the answer is, once again, how long is a piece of string?

If it is a combination of about 4 simple antibodies, possibly a couple of hours.

If it has a strong auto-antibody, and alloantibodies underneath, and requires a cross-match, it could take an awful lot longer.

I think I'm right in saying that the longest I have ever had to owrk (continuously) on a single sample was 10 and a half hours, but that long is unique (or, at least I hope it is - I'd better not say that too loudly as I'm on-call tonight)!

:eek::eek:

I go through TAT stats each month with my manager as do the other areas. of the lab. We basically look at ER. She wants us to justify anything that falls out of the established TAT order-completion(even by 1 minute). THe problem is that we don't alwasy have conrtol over phlebotomy in the ER and sometimes patients are sent to ancillary depts. before sample can be drawn. Oh for the somplicity of a received to completed TAT!

Looks like we are all in the same boat.

:disbelief:sarcastic

Thanks Malcolm. There are times when I want to just tell them "Send it to a real reference lab and see what happens!" But that would not be good customer service...I will try the string comment next time and see if that has any effect.

We have found that when people outside the lab ask about TAT, they typically mean order to result time. We have fought the battle of receipt time as well, but it was a losing fight. We are able to break it down into segments: order to collection, collection to receipt, etc., but to the person that is asking, a request for TAT data generally means order to result time.

( I so agree with the comment above stating that TAT for the physician is from the moment he thinks about ordering it)

Hi Brenda,

Interesting question - we have pneumatic delivery - request is time (&date) stamped on arrival on receivals bench. When G/H or units ready if X/M, report is generated with time of receival entered by scientist from time on form - and time printed. TAT is calculated on that - sampled (x50 random) every six months (50 G/H & 50 X/Ms). Graphs produced on rolling time window for three consec six month periods.

As far as time from draw to receipt in lab - we are a small facility and I have checked that (phlebotomist enters time and date drawn on request) a couple of times and it is consistently <5mins.

True TAT is probably from request, but we don't have electronic request, but for X/M ward cleark pages phlebotomist. You have given me more to think about.

What we do seems to keep regulators happy anyway, but as they look for continual improvement, I am sure it will raise its ugly head at some time.

Cheers Eoin

Back in my previous life I tried to limit my monitors to things I could control so our TAT clock started when the sample arrived in the transfusion service. That was easy becasue the pneumatic system tracked when things arrived for us. I let the phlebotomy supervisor worry about what occurred prior to that.

Even further back when phlebotomy was a responsibility (I still have nightmares from that time!) the clock started when the order was received.

Doctors start the clock when the thought to order something first pops into their head!

Being a smaller facility, I try to show both ordered to received and received to verified in order to see where in lies the issue. My manager has told me many times not to look at the phlebotomy end of it, but it really helps to identify if we have an issue with a particular person or department or even time of day. I will continue to be the squeaky wheel as long as I need to be. I suppose that when I am no longer concerned for any of my family to be treated here I will stop. So that is never!

Receipt in laboratory for transfusion services. However, it depends on whether you have a lab phlebotomy team or if phlebotomy is decentralized. Someone in the lab will be keeping statistics for the lab phlebotomy team.