Use of specimen turnaround time as a component of laboratory quality. A comparison of clinician expectations with laboratory performance.

Quantitative laboratory quality measures include test accuracy and precision. To be useful, however, tests also must be available in a timely manner. The authors surveyed 757 University of California, Los Angeles, house officers (485-64% responded) regarding their expectations of laboratory test turnaround time for five test groups that are regularly offered both stat and routine. They compared expectations with actual laboratory performance by evaluating turnaround time for 42,414 consecutive laboratory requests received over two weeks. The authors' laboratory performed 45% of studied analytes stat. Median turnaround time was 44 minutes for stat and 119 minutes for routine tests, although variation exists by test group. The percentage of time their laboratory met median stat and routine turnaround time expectations varies by shift and work area. Timeliness of results often may be as important as accuracy and precision in assuring quality of care and cost-effective use of hospital services. Although the laboratory may not meet current housestaff turnaround time expectations, it is unclear whether laboratory performance is inadequate or housestaff expectations are unreasonable. Publicizing actual routine turnaround times may reduce the number of stat requests ordered if routine turnaround times are incorrectly perceived to be too slow. Reduction in stat test ordering may improve overall laboratory performance and turnaround time. The authors recommend that clinical pathologists and clinicians together develop turnaround time goals based on practicality, medical necessity, and clinician expectations.