Reduction in laboratory turnaround time decreases emergency room length of stay
Received 3 November 2017
Accepted for publication 22 January 2018
Published 20 April 2018 Volume 2018:10 Pages 37—45
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 2
Editor who approved publication: Dr Hans-Christoph Pape
Nitin Kaushik,1 Victor S Khangulov,2 Matthew O’Hara,2 Ramy Arnaout3,4
1Becton, Dickinson and Company, Franklin Lakes, NJ, USA; 2Department of Health Economics and Outcomes Research, Boston Strategic Partners, Inc., Boston, MA, USA; 3Department of Pathology, 4Division of Biomedical Informatics, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA USA
Objective: Laboratory tests are an important contributor to treatment decisions in the emergency department (ED). Rapid turnaround of laboratory tests can optimize ED throughout by reducing the length of stay (LOS) and improving patient outcomes. Despite evidence supporting the effect of shorter turnaround time (TAT) on LOS and outcomes, there is still a lack of large retrospective studies examining these associations. Here, we evaluated the effect of a reduction in laboratory TAT on ED LOS using retrospective analysis of Electronic Health Records (EHR).
Materials and methods: Retrospective analysis of ED encounters from a large, US-based, de-identified EHR database and a separate analysis of ED encounters from the EHR of an ED at a top-tier tertiary care center were performed. Additionally, an efficiency model calculating the cumulative potential LOS time savings and resulting financial opportunity due to laboratory TAT reduction was created, assuming other factors affecting LOS are constant.
Results: Multivariate regression analysis of patients from the multisite study showed that a 1-minute decrease in laboratory TAT was associated with 0.50 minutes of decrease in LOS. The single-site analysis confirmed our findings from the multisite analysis that a positive correlation between laboratory TAT and ED LOS exists in the ED population as a whole, as well as across different patient acuity levels. In addition, based on the calculations from the efficiency model, for a 5-, 10- and 15-minute TAT reduction, the single-site ED can potentially admit a total of 127, 256 and 386 additional patients, respectively, annually.
Conclusion: A positive correlation between laboratory TAT and ED LOS was observed in a broad patient population and across distinct acuity levels.
Keywords: laboratory testing, turnaround time, emergency department, length of stay, patient acuity, retrospective analysis, data science
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