Reduction in laboratory turnaround time decreases emergency room length of stay
Open accessAbstract
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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Emergency Severity Index level, specialty, destination after ED visit, and number of out-of-range tests were included as proxies for acuity level, which was identified as a confounder in previous studies.
“The Emergency Severity Index level, the specialty, the destination after the ED visit and the number of out-of-range tests were included as proxies for the acuity level, which was identified as a confounder in previous studies [11, 12].”
From Shorter laboratory turnaround time is associated with shorter emergency department length of stay: a retrospective cohort study (2022) · cites this paper as [11]
The multisite Statistical analysis and Results sections (page unavailable) identify severity of illness, measured by the Rapid Emergency Medicine Score, as a confounder. The paper does not identify Emergency Severity Index level, specialty, post-ED destination, or out-of-range test counts as proxies for acuity. (LLM, conf=0.86)
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Vrijsen, B. E. L., Haitjema, S., Westerink, J., Hulsbergen-Veelken, C. A. R., van Solinge, W. W., & ten Berg, M. J. (2022) · BMC Emergency Medicine · doi:10.1186/s12873-022-00763-w · Cited by 20 · see citing works
“A potential determinant of the EDLOS that has been relatively understudied is the laboratory testing turnaround time (TAT) [11, 12].”
BackgroundMethodResultRequiem for the STAT Test: Automation and Point of Care Testing
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Impact of Laboratory Turnaround Time on Clinical Decision-Making and Patient Outcomes
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“The role of Point-of-Care Testing (POCT) will continue to expand, particularly for molecular diagnostics (e.g., rapid PCR for influenza, COVID-19, MRSA), bringing the laboratory to the patient's bedside for an increasing number of assays [29].”
- Authors
- Kaushik, N., Khangulov, V. S., O’Hara, M., & Arnaout, R.
- Affiliations
- Becton Dickinson (United States) (US)
- Beth Israel Deaconess Medical Center (US)
- Corresponding author
- Arnaout, Ramy
- Venue
- Open Access Emergency Medicine
- Publisher
- Informa UK Limited
- Published
- 2018-04
- Volume
- Volume 10
- Pages
- 37-45
- ISSN
- 1179-1500 (ISSN-L)
- PMC
- PMC5916382
- OpenAlex
- W2802725178
- Cited by
- 51
- References
- 23
- Citations by year
- 2026: 3 · 2025: 6 · 2024: 9 · 2023: 8 · 2022: 5 · 2021: 7 · 2020: 9 · 2019: 4
- FWCI
- 6.11
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Open Access Emergency Medicine (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Dove Medical Press (Taylor and Francis Group) (submittedVersion, cc-by-nc)
- Funders
- BD
- Topics
- Health Sciences › Medicine › Emergency Medicine › Emergency and Acute Care Studies
- Health Sciences › Medicine › Physiology › Clinical Laboratory Practices and Quality Control
- Health Sciences › Health Professions › Emergency Medical Services › Healthcare Operations and Scheduling Optimization
- Keywords
- laboratory turnaround time, emergency department length of stay, emergency department efficiency, laboratory testing, hospital bed utilization, electronic health records
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