Reduction in laboratory turnaround time decreases emergency room length of stay

Abstract

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.

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Keywords::

• laboratory testing
• turnaround time
• emergency department
• length of stay
• patient acuity
• retrospective analysis
• data science

Acknowledgments

The authors acknowledge Hussain Badani, PhD, and David K Hayashida, MSc, of Boston Strategic Partners, Inc. for editorial assistance. This study was funded by Becton, Dickinson and Company ([BD]; Franklin Lakes, NJ, USA).

Author contributions

All authors contributed toward data analysis, drafting and revising the paper and agree to be accountable for all aspects of the work.

Disclosure

MOH and VSK were paid by BD to perform the analysis and provide editorial support on the manuscript. RA received an educational grant from BD to conduct the single-site study and provide editorial support for the manuscript. The authors report no other conflicts of interest in this work.

Supplementary materials

Table S1 Inclusion and exclusion criteria to narrow the cohort for multisite study

Table S2 Inclusion and exclusion criteria to narrow the cohort for single-site study

Table S3 Patient demographics and distribution by acuity for the single-site study