QUALITY MANAGEMENT Test Clinical context
Troponin Suspected myocardial infarction; rapid rule-in/rule-out of acute coronary syndrome.
D-dimer INR
Warfarin management, especially in acute settings.
Potassium Critically unwell patients, especially with suspected hyperkalaemia.
Potential harm from delay Delayed initiation of therapy;
increased risk of myocardial damage.
Suspected venous thromboembolism Postponed imaging or anticoagulation; increased (VTE) in ED.
risk of clot propagation or pulmonary embolism. Inappropriate dosing; risk of haemorrhage
or thrombosis.
Delayed intervention; risk of arrhythmia or death.
Table 1. Some common tests where stringent TAT are applied, their risk of clinical harm and the clinical context in which they are used.
n Analytical phase: This includes processing delays due to equipment downtime, sample queuing, or operator workload, and many, many other reasons. This phase traditionally dominates TAT monitoring, but must now be viewed as part of the wider clinical context.
n Post-analytical phase: Result verification, authorisation, and communication delays can negate the benefits of rapid analysis. Laboratories must monitor post-analytical processes as integral to TAT delivery.
Turnaround time requirements must reflect clinical urgency. Results required for immediate clinical intervention (eg troponin for suspected myocardial infarction) should carry different TAT expectations compared to routine monitoring tests. This may even be at the patient location level. Samples from the emergency department (ED), intensive care unit (ICU), or surgical theatre may demand prioritisation distinct from inpatient wards or outpatient settings. Essentially, we must acknowledge not all tests have equal time-criticality. The risk-based approach focuses resources where patient harm from delay is most likely. This may need multi-tiered TAT targets for the same test based on clinical scenario and sample source. Laboratory information systems (LIS), middleware, and workflow design are enablers to manage these complexities reliably.
Clinical harm from delayed TAT Delayed laboratory results can cause direct harm to patients, both through failure to initiate timely treatment and through diagnostic uncertainty delaying appropriate intervention (Table 1). When setting TAT targets and designing monitoring processes, clinical risk assessment must explicitly link each test to the potential harm caused by delay. Laboratories need to recognise – and clearly communicate – that TAT breaches are not just failures to meet performance indicators; they represent a tangible and measurable risk to patient outcomes.
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Developing risk-based TATs: Methodology
Laboratories must avoid setting arbitrary or operationally convenient targets and instead define TATs that reflect clinical risk, patient need, and operational capacity. A structured risk assessment forms the foundation of this process, drawing on established tools such as Failure Mode and Effects Analysis (FMEA) and risk matrices. FMEA supports the identification of failure points where delays may occur, assigns severity, likelihood, and detectability scores, and prioritises risks using calculated Risk Priority Numbers (RPNs) – we have covered this in detail previously. Tests associated with high-severity clinical harm should be prioritised for tighter TAT controls. Risk matrices, aligned with ISO 22367:2020, enable laboratories to stratify risks using severity-of-harm scales, with clinical input required to define acceptable versus unacceptable delays. While laboratories can lead technical risk assessments, defining clinically acceptable TAT targets demands formal consultation with clinical stakeholders. This should include ED leads, critical care clinicians, relevant specialist physicians such as haematologists and biochemists, and clinical governance or patient safety committees. Laboratory-derived TAT targets must be validated through clinical consensus, particularly regarding the point at which delays translate into increased patient harm. Where national guidelines or published
TAT standards exist – such as those from NICE – laboratories should reference them during the TAT definition process. However, such standards must be critically assessed against local operational constraints, patient demographics, and requesting patterns. Published standards should not automatically dictate laboratory targets without local, risk- based validation – at least in my opinion, for what that’s worth. Finally, of course, all decisions
relating to TAT targets must be formally documented within the laboratory’s quality management system (QMS). This
documentation should include a summary of clinical consultations, the rationale for risk-based decisions, approved TAT targets (differentiated by test, urgency, and location), and descriptions of operational monitoring and escalation processes. Maintaining these as controlled QMS documents ensures compliance with ISO 15189:2022 and provides full traceability for internal audits and external assessments.
Training and organisational integration A risk-based approach to TAT management requires active participation from all laboratory staff – not just management or quality teams. Embedding TAT awareness as part of the laboratory’s culture is essential to sustain compliance and protect patient safety. Turnaround time management should be embedded into staff training programmes from induction onwards. Medical laboratory assistants must understand the importance of prompt specimen handling and be able to recognise high-priority samples. Biomedical scientists should be trained to understand the clinical urgency linked to specific tests and the protocols for prioritising urgent samples. Senior scientists and managers need to be equipped to lead real-time workflow interventions, monitor TAT compliance data, and respond effectively to breach alerts. Training should emphasise not only the procedural aspects of TAT management but also its clinical importance, reinforcing the link between laboratory performance and patient outcomes. In our laboratory we have a bell that we ring to indicate a particularly urgent sample so everyone knows!
n Promoting a team-based approach Turnaround time compliance should be framed as a shared responsibility across the laboratory. All staff should feel empowered to monitor workflows and escalate concerns about potential delays – this is part of ongoing staff feedback. Daily meetings and shift handovers provide opportunities to highlight current TAT performance and address emerging risks. Ongoing review of TAT monitoring should be shared between quality, operational, and management teams, encouraging collective ownership.
n Integrating TAT into departmental objectives
Turnaround time performance should be incorporated into the laboratory’s strategic objectives and service improvement projects, positioned as a shared team goal rather than an individual performance
AUGUST 2025
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