Pathology processes and emergency department length of stay: the impact of change

Authors: Andrew Georgiou and Johanna I Westbrook

Med J Aust 2009; 191 (6): 359. || doi: 10.5694/j.1326-5377.2009.tb02833.x
Published online: 21 September 2009

To the Editor: Francis and colleagues revealed a significant 29-minute decrease in the median emergency department (ED) length of stay and reductions in mean turnaround times for full blood count requests following the redesign of pathology processes.1 Laboratory performance and clinician satisfaction are intrinsically bound up with the timeliness of test results, not least because of their effects on patient diagnosis and treatment. The association between test turnaround times and ED length of stay is difficult to decipher. The reasons for this, as pointed out by Francis et al, include the many potential variables that contribute to patient length of stay in EDs. Turnaround times can also vary dramatically according to laboratory operating procedures and work processes. Nevertheless, there is a strong imperative to monitor these indicators as contributors to designing effective interventions to improve the quality and outcomes of patient care.

Our research has also revealed that pathology test turnaround times are a significant contributor to ED length of stay at a major teaching hospital in Sydney. Using regression analysis to account for a number of contributing length-of-stay variables (eg, triage category, patient age, number of tests ordered), we produced a model that accounted for 25.4% of the variance in ED length of stay, of which pathology test turnaround time was a significant contributor.2 Further, studies of the effects of electronic test-ordering systems on test turnaround times in five Australian hospitals have shown that introduction of these systems in each instance was associated with significant declines in test turnaround times.2-4 Thus, there appears to be converging evidence of a relationship between efficient test ordering and processing and reduced ED length of stay.5 In addition to the types of interventions described by Francis et al, electronic test ordering should be considered as a system-wide intervention that may contribute to improved efficiency and patient outcomes. Decision support within such systems provides an added ability to provide alerts and guidance in the test-ordering process.

1. Health Informatics Research and Evaluation Unit, University of Sydney, Sydney, NSW.

Correspondence: a.georgiou@usyd.edu.au

Francis AJ, Ray MJ, Marshall MC. Pathology processes and emergency department length of stay: the impact of change. Med J Aust 2009; 190: 665-669.
Westbrook J, Georgiou A, Lam M. Does computerised provider order entry reduce test turnaround times? A before and after study at four hospitals. Proceedings of the XXII International Congress of the European Federation for Medical Informatics; 2009 Aug 30 – Sep 2; Sarajevo, Bosnia and Herzegovina. Amsterdam: IOS Press, 2009. In press. 0_i1091847
Westbrook JI, Georgiou A, Dimos A, Germanos T. Computerised pathology test order-entry reduces laboratory turnaround times and influences tests ordered by hospital clinicians: a controlled before and after study. J Clin Pathol 2006; 59: 533-536. 0_pgfId-1863711
Westbrook JI, Georgiou A, Rob MI. Test turnaround times and mortality rates 12 and 24 months after the introduction of a computerised provider order entry system. Methods Inf Med 2009; 48: 211-215. 0_i1091850
Storrow AB, Zhou C, Gaddis G, et al. Decreasing lab turnaround time improves emergency department throughput and decreases emergency medical services diversion: a simulation model. Acad Emerg Med 2008; 15: 1130-1135. 0_CBBEGFHF