Reducing Laboratory Turnaround Time in Patients With Acute Stroke and the Lack of Impact on Time to Reperfusion Therapy

Abstract

Context.—Timely reperfusion improves the recovery of patients with acute ischemic stroke. Laboratory results are crucial to guide treatment decisions in patients when abnormal laboratory tests are suspected. Objective.—To implement a new laboratory workflow for acute stroke patients and compare laboratory turnaround time (TAT) preimplementation and postimplementation. Design.—We conducted a retrospective pre-post intervention study of patients with suspected acute stroke during the 4-month periods before and after the implementation of a new laboratory workflow process. The improvement process included relocating the specimen registration site, laboratory notification before specimen arrival, a color-coding system on tubes, timing at all processes, and eliminating the smear review if platelets were normal. TATs of the laboratory and door-to–clinical intervention times before and after the improvement process were compared. Results.—Postintervention, median specimen transportation time decreased from 11 (interquartile range [IQR], 8.4–16.4) to 9 minutes (IQR, 6.3–12.8), P, .001. The intralaboratory and total TATs of complete blood cell count, coagulation tests, and creatinine significantly decreased (P, .001 for all). Blood drawn–to–laboratory reported time decreased from 43 (IQR, 36.0–51.5) to 33 minutes (IQR, 29.2–35.8, P, .001). However, door-to-needle time for thrombolysis and door-to-puncture time and door-to-recanalization time for mechanical thrombectomy were not statistically different (P = .11, .69, and .50, respectively). Conclusions.—The new laboratory workflow significantly decreased transportation time, TAT of individual tests, and the blood drawn–to–laboratory reported time. However, the time to treatment of acute ischemic stroke patients was not different between preimplementation and postimplementation.