Evaluation and Management of Laboratory Delays
Immediate Actions When Delays Occur
When laboratory results are delayed, immediately implement a systematic root cause analysis using time-stamped tracking of each process step from order entry through result reporting, while simultaneously initiating empirical treatment for patients with moderate-to-high pre-test probability of disease. 1
Priority Assessment Framework
For patients with moderate-to-high clinical suspicion, begin empirical treatment immediately without waiting for laboratory confirmation, as delays lead to prolonged infectiousness, inappropriate therapy, and missed transmission prevention opportunities. 1
Risk stratify patients based on age >65 years, cardiovascular disease, diabetes, chronic respiratory disease, hypertension, and immunocompromised status to determine urgency of treatment initiation despite missing laboratory data. 1
Patients with mild clinical features and no risk factors can be monitored, but those with risk factors require baseline imaging and closer surveillance even without laboratory confirmation. 1
Systematic Root Cause Analysis
Time-Interval Breakdown Method
Divide the total turnaround time into discrete measurable intervals to identify specific bottlenecks: 2, 3
- Order processing time (from physician order to nurse registration and blood draw)
- Specimen collection time (actual phlebotomy duration)
- ED/clinic waiting time (specimen sitting in department before transport)
- Transit time (transport to laboratory)
- Within-laboratory time (specimen receipt to result availability)
Common Root Causes Identified
The most frequent causes of laboratory delays are order processing time, ED waiting time before specimen transport, and excessive queue times for specific tests: 2, 3
Order processing delays occur when manual entry systems require multiple steps between physician order and specimen collection authorization. 2, 3
ED waiting time contributes significantly when specimens sit in the department rather than being immediately transported, particularly for admitted patients still physically in the ED (43% of delayed tests). 2
Batch processing rather than continuous testing creates artificial delays, as specimens wait for scheduled run times instead of immediate analysis. 4
Specimen transport delays between facilities when referral to reference laboratories is required for specialized testing. 4
Specific Turnaround Time Benchmarks
Compare your measured turnaround times against established benchmarks to quantify delay severity: 2, 3
- Hemoglobin: 18-25 minutes median, with 90% completed within 45 minutes 2, 3
- Potassium: 36 minutes median, with 90% completed within 45 minutes 2, 3
- Any turnaround time exceeding 2 hours risks bacterial overgrowth in culture specimens, causing colony count changes >1 log₁₀ and diagnostic errors. 5
Implementation of Corrective Measures
Communication System Improvements
Establish efficient, well-coordinated information flow between laboratorians, clinicians, and public health officials as the foundation for reducing delays. 4, 1
Implement daily testing protocols rather than batch processing to optimize turnaround time, since direct correlation exists between reporting delays and treatment initiation delays. 4, 1
Use standardized communication models like SBAR (situation, background, assessment, recommendations) to reduce staff-to-staff communication failures that cause delays. 6
Deploy real-time electronic documentation systems with synchronized time stamps to enable continuous monitoring and rapid identification of emerging delays. 7
Process Optimization Strategies
Address the longest time intervals first, as these provide the greatest opportunity for improvement: 3, 8
Reduce order processing time by implementing computerized physician order entry with direct laboratory interface, eliminating manual transcription steps. 2, 3
Minimize ED waiting time by establishing immediate specimen transport protocols rather than waiting for batch pickup, particularly for time-sensitive tests. 2, 3
Consolidate testing at high-volume specialty laboratories that can maintain daily testing schedules and meet recommended turnaround times, rather than dispersing low-volume testing across multiple sites. 4
Quality Monitoring Systems
Establish continuous monitoring with specific performance metrics and corrective action triggers: 7
Track the percentage of specimens exceeding target turnaround time as a key performance indicator, with goals of <5% exceeding benchmarks. 7
Perform monthly root cause analysis on all specimens exceeding turnaround time targets to identify emerging patterns requiring intervention. 7
Document hemolysis rates and recollection requirements (target <6% hemolysis, <0.02% recollection) as indicators of pre-analytical quality. 2
Critical Pitfalls to Avoid
Never allow specimens to sit at room temperature beyond 2 hours before processing, as bacterial multiplication alters colony counts and creates diagnostic errors. 5
Do not assume single elevated pathogen counts from delayed specimens represent true clinical status without considering collection-to-processing time; repeat sampling with immediate processing is necessary. 5
Avoid implementing solutions without measuring baseline performance first, as interventions cannot be properly evaluated without quantified pre-intervention data. 2, 7, 3
Do not overlook the contribution of admitted patients still physically in the ED (up to 43% of delayed tests), as this population requires separate workflow optimization. 2