Arlene M Boelstler1, Ralph Rowland2, Jennifer Theoret3, Robert B Takla4, Susan Szpunar5, Shraddha P Patel6, Andrew M Lowry7, Margarita E Pena8. 1. St. John Hospital and Medical Center, Department of Emergency Medicine, 22101 Moross Road, Detroit MI 48236, USA. Electronic address: arlene.boelstler@stjohn.org. 2. St. John Hospital and Medical Center, Department of Laboratory Services, 22101 Moross Road, Detroit MI 48236, USA. Electronic address: ralph.rowland@stjohn.org. 3. St. John Hospital and Medical Center, Department of Emergency Medicine, 22101 Moross Road, Detroit MI 48236, USA. Electronic address: jennifer.theoret@stjohn.org. 4. St. John Hospital and Medical Center, Department of Emergency Medicine, 22101 Moross Road, Detroit MI 48236, USA; Wayne State University School of Medicine, 540 E Canfield Street, Detroit, MI 48201, USA. Electronic address: robert.takla@stjohn.org. 5. St. John Hospital and Medical Center, Dept. of Medical Education, Detroit MI 48236, USA. Electronic address: susan.szpunar@stjohn.org. 6. St. John Hospital and Medical Center, Department of Emergency Medicine, 22101 Moross Road, Detroit MI 48236, USA. Electronic address: nenomole@gmail.com. 7. St. John Hospital and Medical Center, Department of Emergency Medicine, 22101 Moross Road, Detroit MI 48236, USA. Electronic address: andrew.lowry@providence-stjohnhealth.org. 8. St. John Hospital and Medical Center, Department of Emergency Medicine, 22101 Moross Road, Detroit MI 48236, USA; Wayne State University School of Medicine, 540 E Canfield Street, Detroit, MI 48201, USA. Electronic address: margarita.pena@stjohn.org.
Abstract
OBJECTIVES: To implement collaborative process improvement measures to reduce emergency department (ED) troponin turnaround time (TAT) to less than 60min using central laboratory. DESIGN AND METHODS: This was an observational, retrospective data study. A multidisciplinary team from the ED and laboratory identified opportunities and developed a new workflow model. Process changes were implemented in ED patient triage, staffing, lab collection and processing. Data collected included TAT of door-to-order, order-to-collect, collect-to-received, received-to-result, door-to-result, ED length of stay, and hemolysis rate before (January-August, 2011) and after (September 2011-June 2013) process improvement. RESULTS: After process improvement and implementation of the new workflow model, decreased median TAT (in min) was seen in door-to-order (54 [IQR43] vs. 11 [IQR20]), order-to-collect (15 [IQR 23] vs. 10 [IQR12]), collect-to-received (6 [IQR8] vs. 5 [IQR5]), received-to-result (30 [IQR12] vs. 24 [IQR11]), and overall door-to-result (117 [IQR60] vs. 60 [IQR40]). A troponin TAT of <60min was realized beginning in May 2012 (59 [IQR39]). Hemolysis rates decreased (14.63±0.74 vs. 3.36±1.99, p<0.0001), as did ED length of stay (5.87±2.73h vs. 5.15±2.34h, p<0.0001). Conclusion Troponin TAT of <60min using a central laboratory was achieved with collaboration between the ED and the laboratory; additional findings include a decreased ED length of stay.
OBJECTIVES: To implement collaborative process improvement measures to reduce emergency department (ED) troponin turnaround time (TAT) to less than 60min using central laboratory. DESIGN AND METHODS: This was an observational, retrospective data study. A multidisciplinary team from the ED and laboratory identified opportunities and developed a new workflow model. Process changes were implemented in ED patient triage, staffing, lab collection and processing. Data collected included TAT of door-to-order, order-to-collect, collect-to-received, received-to-result, door-to-result, ED length of stay, and hemolysis rate before (January-August, 2011) and after (September 2011-June 2013) process improvement. RESULTS: After process improvement and implementation of the new workflow model, decreased median TAT (in min) was seen in door-to-order (54 [IQR43] vs. 11 [IQR20]), order-to-collect (15 [IQR 23] vs. 10 [IQR12]), collect-to-received (6 [IQR8] vs. 5 [IQR5]), received-to-result (30 [IQR12] vs. 24 [IQR11]), and overall door-to-result (117 [IQR60] vs. 60 [IQR40]). A troponin TAT of <60min was realized beginning in May 2012 (59 [IQR39]). Hemolysis rates decreased (14.63±0.74 vs. 3.36±1.99, p<0.0001), as did ED length of stay (5.87±2.73h vs. 5.15±2.34h, p<0.0001). Conclusion Troponin TAT of <60min using a central laboratory was achieved with collaboration between the ED and the laboratory; additional findings include a decreased ED length of stay.
Authors: Peter Perrotta; David A Novis; Suzanne Nelson; Barbara Blond; Anna Stankovic; Michael Talbert Journal: Arch Pathol Lab Med Date: 2020-12-01 Impact factor: 5.534
Authors: Sarah Compeau; Michael Howlett; Stephanie Matchett; Jennifer Shea; Jacqueline Fraser; Rose McCloskey; Paul Atkinson Journal: Cureus Date: 2016-10-06