Improving Patient Flow in Healthcare

One of the main focuses of hospital administrators is to improve the quality of care provision and improve patient satisfaction. It is in this regard that they have integrated technology into operations to improve efficiency and achieve value-based, person-centered care practices. However, the majority of hospitals are struggling with issues of operational and financial distress, and few can meet daily patient demand. Diversions, long waits, and delays in hospital’s imaging and laboratory departments is a significant issue in hospitals that have been affecting patient flow and putting patients at risk of suboptimal care and potential harm ( Hawkins, 2007) . Optimizing hospital flow and improving outcomes and patient experience requires an understanding of the turnaround time in hospital imaging and laboratory department. There is a quest to increase the turnaround time in imaging and laboratory as a way of improving patient flow in the hospital. This article explores how hospitals can reduce room turnaround time. The objective is to evaluate the causes of laboratory TAT, identify the causes and appropriate solutions to the issue

The issue 

The point under concern is that most hospitals struggle with turnaround time in the imaging and laboratory departments to improve patient satisfaction and meet the needs of clinical staff. Turnaround time is of utmost importance in the clinical laboratory through they vary since some lab analysis and imaging take more time than others ( Hawkins, 2007) . Some tests are time-sensitive and can cause delays in turnaround time. Laboratory turnaround time also varies among institutions based on the number of staff, size of the laboratory and the facilities within the lab.

Laboratory turn-around-time affects patient care and satisfaction and has been associated with poor patient flow ( Hawkins, 2007) . Hospitals administrators have been overlooking turnaround time in hospitals while looking to improve efficiency. However, studies have shown that this measure can be used by hospital administrators to increase patient satisfaction and improve efficiency. Laboratory turnaround time is crucial since physicians require timely results to make any effective clinical decision. The results from hospital imaging or laboratory tests are used to guide physicians on whether to admit patients discharge them or provide further medication ( Hawkins, 2007) .

No patient wants to spend a lot of time on waiting lines, which makes shorter turnaround time important. The delays in lab test result ad long wait times puts off most individuals planning to visit a primary care physician. As such, the turnaround time in laboratory departments can affect the overall service provision and their satisfaction of patients. Sometimes, these long waiting times can make a huge difference in the health of the patient especially those in emergency departments and can threaten their safety and quality of life.

The key to providing safe medical care lies on making appropriate medical decisions at the right time, which depends on the amount of time take for reports to reach the physician. Conditions with fastest report delivery from imaging and laboratory tests are well treated compared to those with low report delivery ( Hawkins, 2007) . While every pathologist can manage the volume and efficiency of a condition, the difference lies in how fast report delivery arrives from the laboratory. Performance measures such as ensuring accuracy in diagnosis of diseases utilization and having particular interpretation can play a part in the final turnaround time.

Studies have shown that over 70 percent of clinical decisions are based on timely imaging and lab results (Li et al., 2015). In this regard, it is essential to reduce turnaround time in hospital imaging and laboratory tests as one way of assuring provision of quality health care and improving patient flow in a hospital. A lower turnaround time indicates the efficiency of a hospital laboratory. As a result, there is need to reduce turnaround time in hospital departments as a way of increasing patient satisfaction and revenue The idea is that a waiting patient will spend less time in the emergency department if results are reported faster and will market the efficiency of laboratory services.

Another issue apart from reducing turnaround time in laboratory departments is to ensure the accuracy of reported data needed to provide appropriate medication. The lab technicians have to ensure they provide accurate and efficient results from the tests and screening to help physicians during the diagnosis and treatment. This relies on having enough qualified staff and the necessary facility to complete the tests. Any chances of mislabeling or incorrect information can require lab technicians to retake the tests which may increase patient waiting time while affecting the efficiency of a hospital laboratory (Behling et al., 2015).

Contributing factors 

Identifying the contributing factors to turnaround time in hospital imaging and laboratory tests can be one way of dealing with the issue. The focus is to define functions within the hospital that causes a delay in reporting test results. Several factors are associated with creating turn-around-time in hospital imaging and laboratory department. One of the elements is the sensitivity of a specific test (Li et al., 2015). There are instances where physicians in the laboratory cannot lower the turnaround time of a test as it takes a longer time to read and analyze compared to others. This means patients have to stay on the waiting line to get results for the screening and tests, increasing the turnaround time. Lab technicians have to look at different ways through which they can perform the analysis to make it faster.

Cost is another factor contributing to turn-around-time in the hospital. Insurance companies and health providers may be looking to reduce the cost throughout the medical field, and may not invest in resources that can reduce turnaround time. When hospitals are not willing to investigate the root cause of the problem due to a focus on costs, they are not in a position to fix the problem (Malone, 2014). At the same time, hospitals are under pressure to reduce the cost and increase efficiency in their operations while still maintaining the quality of service provision. This pressure has forced laboratories to avoid investing in any activity that can reduce turnaround time in imaging and lab test results.

At the same time, hospitals with turnaround time problem have not integrated expensive technology in their operations. Improving turnaround times relies on setting up state-of-the-art equipment that can sometimes require higher costs. However, the focus on reducing costs mean hospitals without enough material cannot manage to deal with the high demand for laboratory tests. Whenever the number of patients needing tests and imaging exceeds the facilities at the laboratory, there are high chances of turnaround time that may affect the quality of

Another contributing factor to room turnaround time in imaging and laboratory tests is the size of laboratory and resources within the facilities. Some hospitals may have underequipped laboratories without enough resources to handle a more significant number of tests effectively (Li et al., 2015). This may be in the form of a few staff or facilities that can allow for faster tests and imaging activities. The number of tests may overpower the capacity of the laboratory, thus delaying the reporting of results and affecting the efficiency of patient care. For example, a hospital may have one laboratory that is required to carry out all screening and tests and has to complete tests for multiple demands from the physicians. Such a facility can be overworked and can increase the turnaround time.

Lack of adequate staff within the laboratory can also cause high turnaround time and affect the quality of patient care. Having an insufficient team to deal with the demand for lab tests and screening exercises can contribute to high turnaround time. The under-equipped laboratory means patients will have to wait for long hours to receive tests for their specimen and physicians cannot provide adequate services. Another factor can be the presence of unequipped staff that does not have the necessary expertise to speed up testing, thus slowing down the whole process. There is also a problem of the mislabeled or unlabeled specimen in some laboratory facilities that create a need for reevaluation. Mislabeling is a considerable problem and contributor to turnaround time in hospitals since laboratory technicians are forced to correct the specimen and find the correct label to match the right patient, which requires more time (Behling et al., 2015).

Solutions 

The answer to this problem is to find ways and reduce the turnaround time which can then cut the long wait times. Technological advancement can be used to reduce the effect of turn-around time in the health sector. With the much advancement in technology, numerous tools can be integrated into the hospital setting to improve turnaround time in hospital imaging and laboratory tests. Jackson (2015) said that workflow strategy tweaks and technological advancements could help hospitals to drive down their turnaround time. Integrating technology into every activity can benefit the turnaround time in hospital imaging and laboratory tests by increasing the productivity of employees and reducing the turnaround time.

While it is not possible to alter tests that are time sensitive, a hospital can train its employees and increase their expertise in lab testing and imaging. This can ensure that they read tests faster or are efficient in conducting hospital images, thus reducing turnaround time (Jackson, 2015). Employees need additional skills other than just the ability to read results more quickly. Instead, they lack the knowledge and skills to read every lab test result accurately and within the fastest time possible. This is because scanning the test results without correctly interpreting them can result in inefficient consequences which can misguide physicians when making clinical decisions. In the long run, the health and safety of patients will be at stake.

Another solution is to use real-time turnaround time monitors as automation machines to deal with the delay and wastages. Malone (2014) mentions the monitor tool or pending monitor can be applied in laboratory departments and hospital imaging when carrying out the tests to improve efficiency. The device is strategically placed in an area where medical technologists conducting the tests and imagery can look at it to monitor the status of each tube. This is, therefore, a technological tool that can help physicians to gather data from barcode scanners embedded in the automation line and make quick but accurate reports to help the doctor. In using the monitor tool, there are columns on the screen that show each test name, the location of the most recent spot of the test, date, and tie of the collection as well as the location of the patient (Malone, 2014). The screen on the monitor also can flash broadcast alerts focusing on the amount of time taken to complete the test.

Implementing administrative measures into the hospital can be another solution to turnaround times within hospital imaging and laboratory tests. The administrators can improve the quality of services of the laboratory through several measures such as setting up sample collection counters in both inpatient and outpatient departments to eliminate the time taken in getting the correct specimen to and from the laboratory. Secondly, the administration can print the exact directions for reaching the laboratory on both the outpatient and inpatient department ticket to ease the time taken sending the specimen for diagnosis.

There should also be an initiative to ensure the barcoding of patient’s specimen is completed at the patient’s bedside. This can be one way of making it easy to identify the patient with a specific sample and reduce chances of the unlabeled or mislabeled specimen that can affect proper diagnosis and treatment. In most cases, a mislabeling of specimen results to increase d time checking for the correct sample for testing. Hospitals can use a handheld technological device in positively identifying patients and printing the appropriate barcode for the specimen (Behling et al., 2015). Implementing this new system can help hospitals to reduce the routine of turnaround time in laboratories and hospital imaging since the processes will be completed by the patient rather than by clinicians in the lab.

Another way to manage turnaround times in hospital imaging and laboratory departments is to empower employees by providing information about the problem and how they can help to reduce it. This can be a form of training focused on increasing staff skills on how to use technology to increase efficiency. Lab staff training on new routines for sample collection can be one way of improving the effectiveness of the physicians. Additionally, having regular follow up meetings to review the issues of turnaround time and how to grow can be another solution to the problem.

Hospitals can improve turnaround time by integrating technology such as auto validation among other technological tools. Applying technological devices such as the pending monitor in laboratory departments and hospital imaging reduces the workload from technologists so that they can focus on other aspects that can help to lower the turnaround time. The machine also increases efficiency in monitoring and reporting test results to physicians to allow them in making a diagnosis and reducing patient wait time ( Gupta, Kapil & Sharma, 2018) .

Use of six sigma methodologies at the laboratory departments is part of the technology that can help discover bottlenecks and wastes that occur during the tests, then streamline the process to reduce patient wait time and improve lab turnaround time. Lean analysis can be used by shortening the time between the lab order and availability of results by eliminating wastes ( Gupta, Kapil & Sharma, 2018). This entails reducing the time taken in the specimen collection process. Non-productive time can be reduced by leveling loading work among physicians and squeezing activities. For example, the hospital can evaluate the workload within the hospital and determine where there are wastes in the workforce before optimizing the process.

Another solution is to deal with the size of the laboratory, either by increasing the size of the labor creating another laboratory to help in running the tests and reduce waiting time. There is also a need to separate laboratory department under one authority and ensure there is maximum attention on the crucial process (Khan, 2014). Since physicians rely on lab results to make patient management decisions, making improvements in the lab processes that have a ripple effect on patient wait time in the emergency department. Increasing the number of laboratories can be a solution to provide appropriate support to the imaging and testing process.

Increasing the number of lab staff in a hospital can be another way of reducing delay and patients waiting time. Having more team can also support workflow within the hospital imaging and laboratory tests, which is achievable by evaluating the workload at the facility. For example, hospital administration may decide to shift the workload between laboratories as one way of reducing the turnaround time.

Conclusion 

Hospitals are always looking for ways to reduce patient waiting time and length of stay that arises from laboratory screening and tests. The imaging and tests are crucial for diagnosing and providing quality treatment services to patients. However, hospitals have been grappling with the issue of turnaround time in imaging and laboratory departments which has since affected the efficiency as well as the quality of providing care. Reducing the turnaround time is the appropriate solution to reduce patient wait time and delay. With advancement in technology and the evolution of medicine, it is crucial for hospitals to reduce turn-around time and increase the quality of service provision. The solution requires to first understanding the contributing factors to increased turnaround times and solutions that can help reduce the delay. Hospitals can reduce the turnaround time by focusing on the factors contributing to the issue. Turnaround time in hospital imaging and laboratory department arises from several causes, though they are all intertwined. They include improving staff efficient, integrating technology in the laboratory as well as increasing the functioning and size of the lab. Several hospitals have attempted to achieve a more rapid turnaround time and applying these solutions can finally help improve patient satisfaction and meet the needs of clinical staff.

References

Behling, K., Marrone, D., Hunter, K., & Bierl, C. (2015, September). Decreased Clinical Laboratory Turnaround Time After Implementation of a Collection Manager System. Retrieved November 28, 2018, from http://www.archivesofpathology.org/doi/10.5858/arpa.2014-0529-LE 

Gupta, S., Kapil, S., & Sharma, M. (2018). Improvement of laboratory turnaround time using lean methodology.  International journal of health care quality assurance ,  31 (4), 295-308. 

Hawkins, R. C. (2007). Laboratory turnaround time.  The Clinical Biochemist Reviews ,  28 (4), 179. 

Jackson, W. (2015, November 12). In Radiology, Turnaround Time is King. Retrieved November 4, 2018, from http://www.diagnosticimaging.com/practice-management/radiology-turnaround-time-king 

Khan, K. (2014). Root Cause Analysis (RCA) of Prolonged Laboratory Turnaround Time in a Tertiary Care Set up. Journal of Clinical & Diagnostic Research , 8 (4), 5–8. https://doi-org.csuglobal.idm.oclc.org/10.7860/JCDR/2014/7269.4255 

Li, L., Georgiou, A., Vecellio, E., Eigenstetter, A., Toouli, G., Wilson, R., & Westbrook, J. I. (2015, January 06). The Effect of Laboratory Testing on Emergency Department Length of Stay: A Multihospital Longitudinal Study Applying a Cross ‐ classified Random ‐ effect Modeling Approach. Retrieved November 4, 2018, from https://onlinelibrary.wiley.com/doi/full/10.1111/acem.12565 

Malone, B. (2014, July 1). What Does Turnaround Time Say About Your Lab? Retrieved November 28, 2018, from https://www.aacc.org/publications/cln/articles/2014/july/turnaround-time