Background Public Health Wales NHS Trust (PHW) is responsible for Microbiology laboratory services that support NHS Wales. The testing capacity within the laboratories was increased rapidly. There was a requirement to improve laboratory turnaround time for samples to enable results to be provided to individuals as quickly as possible.
As laboratory capacity increased, turnaround times did not improve. The following issues were identified:
Variation in turnaround times for different populations.
A lack of understanding of daily demand for tests
Lack of standard processes for handling samples upon arrival in the laboratories
Objectives The aim was that within 3 months, 80% of all samples would be turned around within 12 hours of receipt in the laboratory. A stretch goal of achieving 95% by the summer. The work consisted of:
Engagement with all laboratories
Mapping sample flows
Development of dashboards to understand flow, demand and activity
Mapping of in-laboratory processes
Modelling sample flows
Methods Using a Lean methodology, the following were implemented:
Flow of all asymptomatic community samples to a dedicated high volume laboratory
Standard process for receipt of samples, including prioritisation
Improved flow of samples around laboratories
Daily meetings to discuss on-going issues and an opportunity to share good practice
Laboratory process redesign
Results Improvement work commenced in January 2021. As a consequence, times improved across all laboratories (figures 1–4). Median turnaround time reduced from over 24 hours to 6 hours. This has been sustained. 80% of samples are now turned around within 12 hours.
Conclusions The need for rapid turnaround of Covid-19 samples is essential. As a consequence of a national improvement program 80% of all samples have a turnaround time of 12 hours of less.
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