Identify Causes of Unacceptable Turnaround Time in Sample Recalls and Develop Corrective Actions to Improve Patient Service in the Clinical Laboratory

Background: The objectives of this project were to identify the causes of cancelled laboratory tests attributed to the preanalytical phase of testing, determine the most frequent, actionable cause, and work collaboratively to create a standard workflow to improve the quality of testing while concurrently saving wasted money and resources. For tests that were inevitably canceled, we focused on reducing the time from test cancellation to patient recall, thus improving quality of patient care by acting sooner to get results to the primary care provider. Materials and Methods: We collected baseline data on time of cancelled test to time of patient recall, as well as reasons for test cancellation. We identified the top cause for test cancellation was hemolysis and worked to create a standard workflow to reduce the numbers of specimens sent to the Regional Lab that would ultimately be cancelled and result in a patient recall. Additionally, we created a standard workflow to respond to cancelled tests faster, reducing delay in reporting results. Data was gained from daily canceled test reports sent to our facility lab from the Regional Lab. A manual log was kept to track when hemolyzed specimens were acted upon before being transported to the Regional Lab. Detailed information was logged on the specimen intervention. Results: A significant reduction in tests cancelled due to hemolysis was observed following the introduction of the standard workflow. Improvement in time from canceled test to patient recall was also observed after implementing a standard workflow. Although, there is room for further improvement. Conclusions: We show a practical and effective methodology for the identification of sources of preanalytical errors leading to test cancellation, as well as minimal delay in time of result attributed to the need to recall the patient. Our work ultimately resulted in cost savings and better patient service in the clinical laboratory