Turnaround-Time Optimization in Mixed Routine-and-Emergency Clinical Laboratories (Published)
Turnaround time (TAT) serves as a critical quality indicator in clinical laboratories, yet facilities processing both routine and emergency samples face unique operational challenges in optimizing performance across competing specimen streams simultaneously.Conventional improvement approaches addressing prioritization, staffing, analyzers, or reporting in isolation fail to resolve the systemic interdependencies that generate delays in mixed-workload environments, frequently producing temporary gains that degrade as unaddressed bottlenecks emerge.This mixed-methods study, conducted within a Lean Six Sigma DMAIC framework, developed and validated an integrated operational optimization model specifically designed for laboratories managing dual routine-emergency workflows. The model simultaneously addresses four interconnected domains: intelligent workload prioritization, flexible staffing patterns, optimized analyzer utilization, and streamlined reporting pathways.Time-motion studies, laboratory information system data extraction, structured staff interviews, and process mapping across three tertiary care hospital laboratories informed model development, with validation through pilot implementation and discrete-event simulation modeling.Baseline analysis revealed that stat samples exceeded institutional targets 34% of the time, with root causes including inflexible staffing configurations, analyzer capacity constraints during peak periods, and post-analytical verification bottlenecks accounting for 80% of total delay. Implementation of the integrated model reduced median stat TAT by 27% (52 to 38 minutes) and routine TAT by 23% (145 to 112 minutes), with 90th percentile improvements of 28% and 33% respectively. Analytical quality metrics remained stable or improved, while staff workload perception scores increased significantly and turnover rates decreased by 50%. This evidence-based framework provides laboratory leaders with a comprehensive, practical approach to achieving sustainable TAT optimization that enhances patient care, supports clinical decision-making, and demonstrates laboratory value in an era of increasing healthcare demands and performance expectations.
Keywords: Operational Efficiency, Quality Management, analyzer utilization, clinical laboratory operations, laboratory staffing, lean six sigma, mixed-workload management, routine sample workflow, stat sample processing, turnaround time optimization