The present study was a descriptive, cross-sectional study which was conducted on patients who attended the Medicine and Surgery OPD and on those who were admitted to the Medicine and Surgery In-patient Department (IPD), of a tertiary care, state government medical college and hospital. One hundred patients (25 each from the Medicine and Surgery OPD and IPD) were selected by using a simple random sampling technique. Only those patients were included, who were advised Complete Blood Count (CBC) and/or Urine Routine examinations, who were unrelated to any staff member of the hospital, whose test order was not marked as ‘urgent’ or ‘emergency’ and whose tests were performed free of cost i.e. there was no need to go to the cash counter for paying charges for the test. The TAT of Pathology investigations in the selected patients was observed and the RCA of the delays which were detected in TAT was done. Salient recommendations were formulated on the basis of the findings.

A flow chart was created to identify key steps in the laboratory process [Table/Fig-1]. This allowed the measurement of seven events (i.e., six time intervals, D1 to D6 [Table/Fig-1] and overall TAT.

[Table/Fig-1]:

Key steps in the laboratory process

The existing process and time which was required for final delivery of the report to the ward in case of indoor/admitted patients and also, receipt of the report by the OPD patients were also studied.

Ten groups of five patients from different departments and wards were accompanied by volunteers who helped the patients to get their investigations done. The volunteers tried to reduce the time intervals as far as possible, without actively interfering with the steps. The results which were obtained were accepted as standards or controls [Table/Fig-2].

The 100 cases which were studied and their samples were traced passively by using a time motion study. The patients, their accompanying persons and concerned administrative key persons were interviewed directly for obtaining necessary information. The results which were obtained for these 100 cases were compared with the standard or control time intervals [Table/Fig-3 and 4].

[Table/Fig-3]:

The time intervals studied in the 100 cases

The data was collected in an MS Excel sheet and it was analyzed by frequency distribution and descriptive statistics, along with other parametric and non-parametric tests accordingly, by using Epi-info 7 and SPSS, version 14.Chikago.inc.

The age of the study population ranged from 19 to 85 years, with a mean of 41.7 years. Male and female patients accounted for 52% and 48% of the study population respectively. Complete Blood Count (CBC) and Urine Routine examinations, the two most commonly advised pathological tests, were studied for their turnaround times (TATs).

CBC was advised in 89% of the study population and 46% were advised Urine Routine Examination. Eighty eight percent of the patients were also advised some other investigations which were mostly biochemical tests. [Table/Fig-2] shows the descriptive statistics of the 100 cases. Maximum time which was needed in almost all of the cases was between the preparation of test requisition and the reaching of the patient at the central laboratory.

[Table/Fig-2] shows the time intervals studied in the 100 cases. [Table/Fig-5] shows the descriptive statistics of the 50 control or intervention cases.

[Table/Fig-6] shows the parameters studied and their values along with the control values for each. Please refer to [Table/Fig-1] for further clarifications about the parameters.

The maximum time which was needed in the control group was in D1b i.e. the interval between prescription of the investigation by the doctor and the writing of the requisition by the OPD staff for the said investigation. But for the study population, the maximum time which was needed was in D2b i.e. the interval between writing of the requisition by the OPD staff and the reaching of the patient at the central Laboratory. The standard deviation (27.665) and range (102) were also exceptionally high for this interval in the cases group.

[Table/Fig-4] shows the comparison of the six time intervals between the case and control groups of 100 and 50 patients respectively.

The above [Table/Fig-5] shows that all the time intervals, both in case of the OPD and IPD cases, were high in the study group in comparison to the control group and they were found to be statistically highly significant (p<0.05) within a 95% confidence interval of the difference.

The time motion study and direct interviews revealed the following: The manning and control of Pathology subunit was undertaken by the office of the Medical Superintendant cum Vice Principal (MSVP); whereas those of the Microbiology and Biochemistry subunits were undertaken by the respective departments of the Medical College.

In the same complex of central Laboratory, in three separate rooms, a single patient was pricked thrice if he/she needed tests for haematology (say, blood RE), microbiology (say, malaria antigen) and biochemistry (say, blood sugar, urea or creatinine).

These three reports were to be collected by the patients from three different tables and may be at variable time intervals [Table/Fig-7 and 8].

[Table/Fig-8]:

The reception counter at the Central Laboratory is devoid of any sign boards or directions in any vernacular languages

The following were the mean differences in time intervals of TAT between the study group and the control group and the causes, along with their suggested solutions.

The extent to which improvements in laboratory turnaround time enhance patient outcomes is still unclear [11]. A critical issue is clinicians’ capacities in responding to, and making clinical use of faster results. The limited data which are available to date are not encouraging. A UK study which investigated the impact of ward computers which allowed access to laboratory results, found that 45% of urgent requests for biochemistry tests from accident and emergency wards, and 29% from inpatient wards, were never accessed. Of the results which were never read, 3% were assessed as necessitating an immediate change in patient management. [12]. Clinicians report dissatisfaction with current tracking and follow up of test results [13]. So, unless clinicians’ behaviours change, for utilizing faster results, we face the risk of over optimizing a single system. Additional system features such as e-mail inboxes which post important results to clinicians directly, or computer alerts which highlight urgent results, may help in supporting a better test management [14].

The present study arrived at the following conclusions: The Turn-around Times of investigations which were performed at the central Laboratory, especially the pre and post-analytical steps, were prolonged and these were statistically significant.

In the observed TAT of the study population, maximum time needed was in the interval between writing of the requisition by the OPD staff and the reaching of patient at the central Laboratory. Hence, employment of minor methods, like printing the directions for reaching the laboratory on the OPD ticket, would substantially bring down the TAT and subsequently increase patient satisfaction.

This study also revealed that certain easy to implement administrative steps would also help in reducing the TAT significantly and simultaneously improve the quality of services of the central Laboratory as a whole. These include the setting up of sample collection counters at the OPD and IPD, the start of a single prick policy and declaring central Laboratory as a separate department.

The TAT can be substantially reduced if minor assistance without active interference is provided to the patients. This was observed in the present study, among the control group of patients.