Weekly laboratory turn-around time identifies poor performance masked by aggregated reporting

Area of Science:

• Clinical diagnostics
• Laboratory management
• Public health surveillance

Background:

• National Health Laboratory Service (NHLS) in South Africa uses high-level TAT reports for performance assessment.
• Aggregate TAT reporting masks individual laboratory performance across the NHLS network.

Purpose of the Study:

• To investigate weekly TAT reporting for identifying laboratory inefficiencies.
• To enable targeted interventions for improving laboratory performance.

Main Methods:

• Extracted CD4 TAT data from 46 laboratories for the 2016/2017 financial period.
• Calculated total TAT median, 75th percentile, and percentage of samples meeting the 90% within 40-hour cut-off.
• Analyzed TAT components (pre-analytical, testing, review) and provincial performance classifications.

Main Results:

• Annual median TAT was 18.8h, 75th percentile was 25h, with 92% of samples meeting the cut-off.
• Component TAT 75th percentiles: pre-analytical 10h, testing 22h, review 1.6h.
• Weekly analysis revealed 28.6% of labs had no outlier weeks, while 6.5% had over 10 outlier weeks.

Conclusions:

• Weekly TAT analysis unmasked under-performing laboratories requiring immediate intervention.
• Component TAT analysis identified specific areas for targeted improvement in laboratory processes.