Assessment of Turnaround Time (TAT) and Specimen Rejection Rates: A Joint Quality Improvement Initiative Between Nursing and Clinical Laboratories

Abstract

Background Laboratory test results are instrumental in making a large proportion of clinical decisions. However, most of the delays and errors happen in the pre-analytical phase, which is mostly performed by nurses outside of the laboratory setting. Turnaround time (TAT) and specimen rejection are two important performance indicators of this phase; however, they are rarely shared between nursing and laboratory services. Objective: The purpose of this study was to assess turnaround time (TAT) and specimen rejection rates pre and post collaboration among nursing and laboratory departments within the same tertiary teaching hospital. Methods: We performed a Plan-Do-Check-Act, pre-post quality improvement. Laboratory data were extracted from laboratory information system data collection pre intervention (January to June 2025, 48620 specimens) and compared to post intervention (August 2025 to January 2026, 50310 specimens). Interventions included nurse- laboratory joint training, bedside bar coding, unit liaison nurses, collection checklist and monthly feedback dashboard. Rejection rate were analyzed with the χ2 test and TAT intervals (median, interquartile range) were compared using Mann-Whitney U test. Outcomes: The total rejection rate fell from 2.50% to 1.27% (RR 0.51; 95% CI 0.46-0.56; p < 0.001). Hemolysis and clotting remained the dominant causes of rejection but declined by 46.9% (95% CI 42.4% to 51.5%) and 49.2% (95% CI 43.9% to 54.5%) respectively per 1000 specimens. Labeling errors were reduced by 59.7% (95% CI 55.2% to 64.1%). Total TAT for stat tests fell from a median of 78 minutes to 58 minutes (p < 0.001), while the percentage of results returned within 60 minutes increased from 41.2% to 68.5%. Knowledge scores in nurse questionnaires increased from 61.4% to 82.7%. Conclusion: An interdepartmental collaborative project including Nursing and Laboratory departments reduced specimen rejection and TAT. The shared indicators, bedside identification by barcoding and feedback on a regular basis may be the adaptable model for the pre-analytical quality control.