Improving Emergency Department Length of Stay by Reducing Laboratory Turnaround Times

Abstract

The purpose of this quality improvement project was to improve lab turnaround times to decrease Emergency Department (ED) length of stay. The project participants included registered nurses (RN) and medical doctors (MD) in the ED and medical technologists (MT), medical laboratory technicians (MLT), and phlebotomists in the laboratory. EDs are challenged with diagnosing and treating patients promptly and often encounter delays from outside factors. One of those includes laboratory turnaround times (TAT). Using lean methodology, interventions selected were put into place in an effort to decrease lab TAT. Standard workflows were developed for lab and ED team members. ED RNs began using ED protocols to enter pertinent lab orders during triage after assessing patients. ED RNs collected blood samples when starting their intravenous line, and a 5S was carried out to improve workplace organization. ED RN protocol usage improved by 14.7% the first month of the project and continued to improve for a final improvement of 68% compared to the 50% improvement target. The volume of blood samples collected by RNs improved from an average of 476 per month to 535 per month for an increase of 12% vs. a goal of 10%. Workplace organization improved from 8 points to 20 points compared to a goal of 15-20 points. Lab TAT for arrival to first ordered lab for CBCs, BMPs, and Troponins improved from an average of 20.85 minutes to an average of 18.53 minutes. Lab TAT from labs ordered to collection time for CBCs, BMPs, and Troponins also improved from an average of 19.88 minutes to an average of 17.37 minutes. This project improved the overall lab TAT by 4.82 minutes; however, it did not meet the ED LOS improvement target of 5%.