What Is Turnaround Time, How to Measure TAT, and Strategies for Effective Implementation and Improvement
Introduction to Turnaround Time (TAT) for Laboratories
The speed at which laboratory test results are processed and delivered is critical, as faster results and the informed decisions they enable can be lifesaving. According to the Centers for Disease Control and Prevention (CDC), 70% of today’s medical decisions rely on laboratory test results. However, despite this crucial role, nearly 80% of clinical labs report receiving complaints about turnaround times. This underscores the pressing need for labs to address the operational hurdles that slow the testing process.
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Laboratory Turnaround Time (TAT) Description
Turnaround Time (TAT) is a key performance indicator for laboratories, representing the total time from sample reception to reporting results. TAT is typically divided into three critical phases:
- Pre-analytical: This phase covers everything from test ordering, sample collection, labeling, and transport to the lab. Delays in this phase can stem from inefficient sample transport or improper labeling.
- Analytical: This is the core testing phase, where samples are processed, analyzed, and interpreted by lab equipment or personnel. Speed and accuracy in this phase are driven by automation and equipment efficiency.
- Post-analytical: This phase includes validation, documentation, and delivery of results. The final stage is where lab reports are generated and dispatched manually or automatically to clinicians or patients. Delays here often arise from manual data entry or a lack of integrated reporting systems.
Beyond these phases, some labs use Total Turnaround Time (ToTAT), which encompasses the entire workflow from the moment the test is ordered to the receipt of results by the clinician or patient. This metric provides a more comprehensive measure of lab efficiency and can reveal bottlenecks outside the core laboratory processes, such as test request handling and result delivery logistics.
TAT requirements vary depending on the type of laboratory:
- Hospitals focus on STAT samples, which are time-sensitive and require immediate processing for critical patient care, often with a TAT goal of under one hour.
- Clinical diagnostic labs manage a high volume of routine tests with a balance between speed and accuracy, with TAT targets often set for 24 hours for most routine tests.
- Research labs prioritize precision and thoroughness over speed, and TAT often takes longer to ensure comprehensive analysis and validation.
Understanding and optimizing each phase of TAT is essential for improving laboratory efficiency, enhancing patient care, and meeting clinician expectations.
Why TAT Matters in a Laboratory
In clinical diagnostics, Turnaround Time (TAT) directly impacts patient outcomes. Fast TAT allows clinicians to diagnose conditions promptly, especially in critical care, emergency departments, and diagnoses where delays can jeopardize patient care, such as oncology, infectious disease, or rare diseases. A shortened TAT improves decision-making speed, enabling rapid initiation of treatment and reducing hospital stays. In clinical diagnostic labs, faster TAT helps optimize lab workflows, reducing backlog and preventing unnecessary duplicate tests. Some organizations impose maximum turnaround times, for example, CDC.gov, in their Infectious Disease Laboratory Test Directory.
In drug discovery and research, TAT plays a different but equally significant role. Rapid processing of experimental results accelerates scientific progress, allowing researchers to iterate quickly and adapt study protocols as needed. Whether analyzing biomarkers, testing compounds, or conducting genetic screenings, a streamlined TAT is vital to maintaining research momentum and avoiding costly delays.
For both clinical and research environments, optimizing TAT improves overall operational efficiency, reduces costs, and enhances data accuracy, all of which are critical for patient safety and innovative drug development.
How to Measure Turnaround Time
A Laboratory Information Management System (LIMS) enhances TAT measurement by digitizing and automating the entire process, tracking each phase end to end:
- Pre-analytical: LIMS records the time from sample collection to receipt at the lab, providing real-time updates on sample transport and logging delays.
- Analytical: The system monitors each test’s progress, capturing when a sample enters and exits the testing phase.
- Post-analytical: LIMS automatically logs report validation and dispatch, reducing manual entry errors and speeding up reporting.
By integrating LIMS with instruments and workflows, lab leaders can track TAT by test type, identify bottlenecks, and generate detailed reports for process optimization. The system also offers dashboards and alerts, ensuring that delays are highlighted and resolved swiftly, improving overall lab efficiency.
Turnaround Time (TAT) Benchmarks Across Different Test Types and National Guidelines
Turnaround Time (TAT) benchmarks vary widely across medical tests and national guidelines. This variability depends on the complexity of the test, the urgency required, and the specific national healthcare guidelines followed by institutions like the CDC or NHS.
TAT in an Emergency Department Setting
In hospital emergency settings, quick TAT is critical. Acceptable TAT for emergency parameters can range from minutes to hours. This quick turnaround ensures that life-saving interventions are not delayed. For example, electrolytes or Prothrombin Time (PT) in a ward setting might have a TAT between 4.5 to 5.5 hours. Still, for emergency settings, the goal is much shorter, especially for urgent markers like Prothrombin Time (30 minutes).
TAT in an Oncology Diagnostics Setting: Lung Cancer Example
In the context of oncology diagnostics, national guidelines set very specific targets for TAT. For instance, the National Optimal Lung Cancer Pathway (NOLCP) in the UK advises that a lung cancer diagnosis should be available within 3 working days, and molecular marker results (e.g., EGFR analysis) should be available within ten working days. However, achieving these targets is often a challenge. An observational UK study reported a median of 18 calendar days from tissue acquisition to EGFR results. Additionally, genomic laboratories generally report results within 21 working days, with biopsy typically completed within 5–7 days, followed by 10–14 days for testing.
TAT in a Genetic Testing for Rare Diseases (NGS-based Diagnostics)
TAT can range dramatically in the case of Next Generation Sequencing (NGS)-based diagnostics for rare diseases. For example, rapid TAT can avoid unnecessary invasive procedures in neonatal intensive care units. However, TAT for NGS diagnostics has been reported to range from 50 hours to 58 weeks, depending on several factors, including the complexity of the test and the coordination between clinicians, bioinformaticians, and molecular geneticists. Effective teamwork and close liaison among all team members are critical to reducing this wide variation.
TAT in Infectious Disease Testing (CDC Guidelines)
The Centers for Disease Control and Prevention (CDC) establishes clear turnaround time (TAT) benchmarks for various infectious disease tests to ensure timely and accurate diagnoses. The TAT guidelines vary based on the test complexity and the urgency of the disease being investigated. Here are some examples of TAT requirements across different infectious diseases:
Measles Serology: For routine IgM and IgG measles serology testing, the CDC sets a TAT of 7 working days from receiving the sample at the reference laboratory. This is a crucial time frame for diagnosing measles outbreaks and enabling rapid public health interventions. In cases of measles exposure or during an outbreak, rapid TAT ensures that public health measures such as quarantining and vaccination can be executed promptly.
Rubella Testing: For rubella IgM and IgG serology tests, the CDC typically reports a TAT of 5 working days after receiving the sample. This shorter TAT reflects the urgency in diagnosing rubella, especially in pregnant women, where timely results are necessary to mitigate the risk of congenital rubella syndrome (CRS). CRS can lead to severe birth defects, so early diagnosis is critical.
Alkhurma Hemorrhagic Fever (AHFV) Testing: AHFV, a viral hemorrhagic fever, requires more specialized testing, resulting in a longer TAT. The CDC estimates a TAT of 2 weeks for serological analysis. This longer timeline is due to the complexity of the disease and the need for confirmatory tests. AHFV is a less common but serious infectious disease, and the CDC emphasizes proper specimen handling and communication with health authorities to ensure accurate diagnosis.
These TAT guidelines are established to ensure timely interventions while balancing the complexity of each test. The CDC sets faster TAT goals for diseases with more immediate public health implications (e.g., measles and rubella). In contrast, diseases that require more complex diagnostic techniques, like AHFV, naturally have longer TATs.
TAT in Biochemistry and Routine Chemistries
A TAT of 4.5 to 5.5 hours is considered acceptable for routine inpatient biochemistry tests. In cases like Outpatient Chemistries, the TAT can extend to 24 hours, but more urgent tests, like Prothrombin Time in outpatient settings, aim for a 1-hour TAT.
Importance of Teamwork and Departmental Handoffs in Managing TAT
Teamwork and departmental coordination are crucial in managing TAT, especially in complex diagnostics like NGS for rare diseases or cancer markers. For example, achieving faster TAT for NGS diagnostics requires collaboration between clinicians, geneticists, and bioinformaticians. The time to results can be reduced significantly when team members work closely, share timely data, and communicate effectively across departments. A Next Generation Sequencing specific LIMS system is also essential to facilitating teamwork collaboration, automating workflow across departments, digitizing data entry, facilitating data sharing, and automating test results approvals and delivery to the clinic or physician.
Close coordination between pathology, oncology, and lab teams is essential in cancer diagnostics to meet strict national benchmarks, such as the 10-day window for lung cancer molecular diagnostics. Failures in communication or workflow management across departments can result in delays that extend TAT and delay crucial treatment decisions.
Sapio LIMS Clinic/Hospital/Physician Order Processing
Key components that contribute to delayed TAT
High Sample Volume and Data Complexity
The average clinical lab processes thousands of samples each day, while large labs can process 10k to 100k samples daily. Coupled with massive volumes of data, stringent quality control requirements, and other complexities, clinical labs require extraordinary efficiency and productivity. This is especially true for labs specializing in next-generation sequencing (NGS) or omics technologies (e.g., genomics, proteomics), which present unique demands for intricate sample management, continuous monitoring, instrument integration, and more.
Errors in Pre-Analytical Testing Phase
According to multiple studies, pre-analytical factors can account for 60% to 70% of TAT delays in clinical laboratories. The pre-analytical phase includes test requests, patient and specimen identification, specimen collection, transport, accessioning, and processing. Using paper requisitions or disparate online ordering platforms can further complicate and impede the process. These outdated methods can lead to inefficiencies, delays, and errors in the ordering and accessioning phases.
Staffing and Workforce Issues
A shortage of skilled laboratory technicians and pathologists can delay the processing and analysis of samples. High workloads and burnout among staff can also affect efficiency and accuracy, further slowing turnaround times.
Sample and Workflow Management
Effective workflow management is crucial in minimizing turnaround times in clinical laboratories. Poor workflow management, such as the failure to prioritize urgent samples and inefficient sample handling procedures, can lead to significant delays. Implementing automated systems and standardized protocols can help streamline processes, ensuring that samples are processed in a timely and accurate manner, thus reducing overall TAT.
Strategies to Effectively Implement TAT
Implementing strategies to optimize Turnaround Time (TAT) is crucial for ensuring laboratory efficiency and meeting diagnostic timelines. These strategies focus on reducing bottlenecks and automating manual processes to create a seamless workflow across all stages of the laboratory process. Below are five key strategies that can help laboratories enhance TAT performance:
Workflow Automation with LIMS:
Implementing Laboratory Information Management Systems (LIMS) is critical for automating and streamlining laboratory workflows across pre-analytical, analytical, and post-analytical phases. LIMS handles key functions such as sample tracking, data management, and report generation, thereby reducing manual intervention and minimizing delays throughout the diagnostic process.
By automating data entry, test order management, and result dispatch, LIMS ensures that test results are available in real-time, enabling faster communication between the lab and clinicians. This eliminates common bottlenecks such as manual data transcription errors or delays in report delivery. LIMS also facilitates seamless integration with other automated systems like analyzers and robotic specimen transport systems, reducing the time between sample collection and result reporting.
For example, LIMS can automatically trigger the next step in the workflow as soon as a sample is processed, whether moving the sample to the next stage of analysis or generating and dispatching the final report. This real-time automation is especially crucial in emergency settings, where rapid decision-making can significantly improve patient outcomes.
Robotic Automation:
Robotic automation and delivery systems are revolutionizing laboratory operations by minimizing delays and improving efficiency in sample handling. Robotic specimen transport systems, such as the Tempus600 pneumatic tube system, automate the movement of samples between departments, eliminating the need for manual transport—a significant source of delays in large, high-volume labs. These systems ensure specimens reach analytical instruments faster, enabling quicker processing and reducing bottlenecks in pre-analytical and post-analytical workflows. In particular, pneumatic tube systems allow continuous, hands-free transfer of samples directly to the relevant processing areas, freeing up lab staff for more critical tasks.
Moreover, automated sample preparation systems like Hamilton Robotics Microlab STAR further streamline operations by handling routine, time-consuming tasks such as aliquoting, centrifugation, and reagent preparation. This automation enhances precision and consistency, reducing errors while significantly shortening processing times. These robotic systems work with Total Laboratory Automation (TLA) platforms, which integrate various automated processes to ensure seamless sample flow from intake to reporting, improving speed and accuracy across the lab. These advancements improve turnaround time (TAT) and patient outcomes, especially in emergency settings where rapid diagnostics are critical.
Streamlining Pre-analytical Processes:
Pre-analytical delays often stem from inefficient sample collection, labeling, or transport procedures. By adopting barcoding systems, samples can be tracked from the moment they are collected, ensuring accurate identification and reducing the potential for mislabeling errors. Optimizing phlebotomy practices—such as ensuring proper venipuncture techniques and reducing wait times between collection and sample processing—can significantly improve TAT. Efficient sample collection and transport are essential for timely diagnostics, especially in high-volume environments.
Quality Control:
Regular equipment maintenance and consistent adherence to quality control (QC) protocols are essential for ensuring that tests are accurate and timely. For example, automated QC checks, conducted every 50 samples, can detect equipment malfunctions early and prevent delays due to re-testing or equipment failures. By implementing continuous quality monitoring, labs can avoid unexpected downtime while ensuring accurate results. Additionally, using machines with higher throughput and automated calibration functions can reduce the amount of manual intervention required, contributing to faster test completion.
Staff Training:
Human-induced delays are often a result of inconsistent workflows or insufficient training in urgent sample processing. Proper training on TAT procedures can significantly enhance laboratory efficiency. This includes training staff on managing urgent or stat samples, properly using automated equipment, and understanding the prioritization of test types. Further, dividing labor appropriately among technicians ensures no bottlenecks in key processing areas. Team members should be clear on their roles in handling urgent and routine tests, minimizing miscommunication, and ensuring smoother transitions between each phase of sample handling.
Improving Report Dispatch:
The post-analytical phase often experiences delays due to manual data entry or report generation. Labs can eliminate these bottlenecks by using a Laboratory Information Management System (LIMS) to upload results as soon as they are validated automatically. When integrated with clinician-facing systems, LIS allows results to be immediately accessible, reducing the delay in report delivery. For example, instant access to lab results can be critical for immediate patient care in emergency departments. Automated alerts can notify clinicians of high-priority or critical results, reducing response times.
Conclusions
Clinical laboratories face significant challenges in turnaround times (TAT), sample traceability, data fragmentation, and compliance, which can hinder accuracy and efficiency. High sample volumes, pre-analytical errors, and workflow management issues delay TAT, while manual accessioning errors and inconsistent tracking systems compromise sample traceability.
Fragmented data from incompatible systems leads to delays in reporting and non-compliance with clinical regulations. Implementing a configurable, no-code Laboratory Information Management System (LIMS), like Sapio LIMS, can address these issues by automating workflows, ensuring real-time tracking, consolidating data, and supporting regulatory compliance. Sapio LIMS improves accuracy and enhances operational efficiency, providing a comprehensive solution for modern clinical diagnostics for better patient outcomes.
Find out more about Top KPIs and Performance Measurement Tools Used in Laboratories.
Introducing Sapio LIMS for Clinical Diagnostics
Sapio LIMS for Clinical Diagnostics is specifically designed to address the complex needs of clinical and molecular diagnostic laboratories. It provides a comprehensive, open, and configurable platform that tracks samples in real-time, unifies test data, automates workflows, and enhances diagnostic accuracy. It supports compliance needs and drives better outcomes, turnaround times, and operational efficiency.
Sapio LIMS Example Patient Laboratory Report
Real-Time Sample Traceability
Sapio LIMS offers real-time sample traceability by providing a comprehensive, up-to-the-minute view of each sample’s location, status, and history throughout its lifecycle in the laboratory. This capability ensures precise tracking and minimizes errors.
Configurable No-Code Workflow
Automate complex laboratory workflows to reduce manual errors, speed up processing times, and increase productivity, allowing lab professionals to focus on critical tasks.
End-to-End Platform
Sapio LIMS offers an end-to-end platform that seamlessly connects every stage of the diagnostic process, from physician portal to result reporting, providing a unified, streamlined, single-user experience.
Unified Data and Reporting
Efficiently manage large volumes of clinical and molecular diagnostic data with Sapio LIMS, ensuring secure storage, easy retrieval, and seamless integration across various laboratory systems.
Built-In Regulatory Compliance
Sapio LIMS supports compliance with industry standards and regulations, provides robust auditing capabilities, and ensures all processes adhere to applicable standards and guidelines.
List of TAT References
1. Goswami, B., Singh, B., Chawla, R., Gupta, V. K., & Mallika, V. (2010). Turnaround Time (TAT) as a Benchmark of Laboratory Performance*. [PMC Article](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2994570/).
2. Dawande, P. P., Wankhade, R. S., Akhtar, F. I., & Noman, O. (2022). Turnaround Time: An Efficacy Measure for Medical Laboratories. [PMC Article](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9535613/).
3. Turnaround Time in the Laboratory. [Source](https://www.tempus600.com/blood-transport/turn-around-time-in-laboratory).
4. Toward Clinical Implementation of Next-Generation Sequencing-Based Genetic Testing in Rare Diseases: Where Are We? [Source](https://www.sciencedirect.com/topics/biochemistry-genetics-and-molecular-biology/turnaround-time).
5. Optimising Tissue Acquisition and the Molecular Testing Pathway for Patients with Non-Small Cell Lung Cancer: A UK Expert Consensus Statement. [Source](https://www.sciencedirect.com/topics/biochemistry-genetics-and-molecular-biology/turnaround-time).
6. CDC Infectious Diseases Laboratory Test Directory. [Source](https://www.cdc.gov/laboratory/specimen-submission/cdc-lab-tests.pdf).
Turnaround Time Frequently Asked Questions (FAQs)
- How do unexpected delays in TAT affect laboratory credibility?
When turnaround times are longer than expected, it can damage a lab’s reputation. Clinicians and patients may lose confidence in the lab’s ability to deliver timely and reliable results, which could lead to them seeking alternatives. Any delay in critical scenarios, such as emergency care, can undermine trust and tarnish the lab’s image. - What role does communication between departments play in reducing TAT?
Good communication between different departments is essential for keeping turnaround times short. When everyone is aligned, it’s easier to prioritize urgent samples, streamline workflows, and quickly resolve any issues that arise during the testing phases. A communication breakdown can easily lead to bottlenecks and extended delays, harming efficiency. - Can TAT improvements lead to better patient trust and satisfaction?
Yes, when test results return faster, the patient experience improves. Quick results mean faster diagnoses, leading to quicker treatments. Patients feel more confident in their care, and clinicians can promptly make decisions. This naturally builds trust and satisfaction, especially when time is of the essence. - How does staff burnout contribute to extended TAT?
When lab staff are overwhelmed or overworked, productivity can suffer, directly impacting turnaround times. Burnout can lead to slower work, increased errors, and even the need for re-tests, all dragging out the process. Ensuring staff have reasonable workloads and the support they need can help maintain a consistent and efficient pace in the lab. - What is the hidden cost of inefficient TAT in labs?
Inefficiencies in TAT can lead to more than just longer wait times. It can drive up the overall cost of patient care, particularly if patients need to stay in the hospital longer or undergo additional tests. There’s also the risk of delayed diagnoses, which can result in poor patient outcomes and even legal risks for the lab. Inefficient TAT can seriously hinder a lab’s performance and profitability in the long run. - How can labs balance TAT reduction with maintaining test accuracy?
Labs need to invest in automation, solid quality control, and staff training to strike the right balance between speed and accuracy. It’s critical to ensure that while results are processed more quickly, they’re still precise and reliable. Automated systems can help reduce human error and allow lab staff to focus on more complex tasks, ensuring both speed and accuracy are maintained.
