QUALITY MANAGEMENT


measure. For leadership and supervisory roles, individual objectives may include responsibilities related to workflow management and TAT performance.


n Embedding TAT within governance structures


Monitoring and management of TAT should form part of routine laboratory governance processes, including management review meetings, audit programmes, quality governance forums, and service-level strategy planning. This ensures that TAT remains visible as a quality metric and patient safety issue, supporting continuous improvement and compliance with ISO 15189:2022 quality management requirements.


Role of IT systems in risk-based TAT implementation Without suitable IT infrastructure, multi-tiered TAT definitions and real- time performance monitoring become impractical, undermining any risk-based TAT framework.


n Laboratory information systems and middleware Laboratory information systems and middleware form the operational backbone of effective TAT management. These systems enable the automated assignment of TAT targets based on factors such as the test requested, clinical urgency, and patient location. They facilitate the prioritisation of samples within analysers and across workflows; for example, by automatically flagging emergency department samples for immediate processing. Real-time tracking of samples throughout their pre-analytical, analytical, and post-analytical stages is also made possible, supporting timely interventions to minimise delays. In situations where the LIS lacks sufficient functionality, middleware or bespoke IT solutions may be required to manage sample prioritisation and ensure compliance with defined TAT targets.


n Real-time monitoring and escalation A risk-based approach to TAT management relies on continuous monitoring rather than retrospective auditing. IT systems should provide live dashboards that display current performance against TAT targets, generate alerts when samples approach or breach defined thresholds, and enable proactive responses such as reprioritisation or reallocation of resources. Responsibility for TAT monitoring should not be assigned to a single individual. Instead, all laboratory staff should understand their role in recognising workflow risks and


intervening promptly to prevent or resolve potential breaches.


n Visual reporting tools To ensure that TAT performance data drive action, visual management tools are essential. Colour-coded dashboards, regular TAT reports, and cumulative trend charts allow TAT performance to become visible and meaningful across all staff levels, from medical laboratory assistants to laboratory managers. These tools transform abstract data into actionable insights.


n IT-enabled audit trails and data storage


Comprehensive, timestamped audit trails should be retained within laboratory IT systems to support retrospective analysis and quality improvement activities. These data enable root cause analysis of TAT breaches, identification of performance trends, and reporting of TAT metrics as KPIs within the laboratory’s quality management system. Incomplete or inaccurate data, such as missing timestamps or inconsistent definitions of sample ‘start’ and ‘end’ points, remains a common challenge. Such issues must be addressed during the implementation phase of any TAT framework to ensure that data are reliable and fit for purpose.


n Ownership and shared responsibility While IT systems automate many aspects of TAT monitoring, ultimate responsibility for managing TAT performance is shared across the laboratory team. Operational staff are responsible for monitoring real-


Step


Establish a TAT Working Group


Define Scope and Identify Workflows


Conduct Risk Assessment


Clinical Consultation and Agreement


Review National Guidelines and Benchmarking


Define and Document TAT Targets


IT System Configuration


Staff Education and Role Assignment


Launch Monitoring and Real-Time Control Description


Form a multidisciplinary team including operational, clinical, and IT staff to oversee TAT processes.


Map laboratory workflows, identify high-risk processes and decide on monitoring scope.


Use risk assessment tools to prioritise tests where TAT delays have greatest impact.


Engage clinicians to define acceptable TAT thresholds and agree on tiered targets.


Reference guidelines and peer benchmarks to validate targets against local needs.


Formally document TAT targets, specifying details for monitoring and review.


Configure IT systems for automated TAT assignment, prioritisation, and alerting.


Educate staff about targets, roles, and shared responsibilities for TAT management.


Implement real-time monitoring tools and empower staff to prevent delays.


Embed into Quality System Integrate TAT compliance into quality KPIs, reviews, and governance. Periodic Review and


Continuous Improvement


Regularly review performance, reassess needs, and update targets as needed.


Table 2. A basic suggested starting point for developing a framework for risk-based review of TAT. WWW.PATHOLOGYINPRACTICE.COM AUGUST 2025 31


time dashboards and intervening when necessary to manage workflow risks. The quality team analyses compliance trends, conducts periodic reviews, and reports TAT metrics as part of broader quality monitoring activities. Laboratory management must ensure that IT systems are appropriately configured, maintained, and integrated into the laboratory’s quality reporting structures. Ultimately, IT systems should be viewed as tools to support a team-driven approach to patient safety, rather than as standalone solutions.


Practical implementation framework


While every laboratory will approach TAT implementation differently based on resources and local factors, the stepwise framework shown in Table 2 provides a structured method to introduce risk- based TAT management aligned to ISO 15189:2022 and ISO 22367:2020 principles. Of course, each of these steps are themselves subdivided by further tasks, each with different members of the project team responsible for each.


Monitoring TAT compliance: Moving beyond averages Historically, laboratories often reported average (mean, median) TATs as a measure of service performance. However, average TAT offers little clinical value. A few extremely delayed samples can be masked by large numbers of routine, fast results. From a patient safety perspective, this approach is inadequate. A risk-based framework requires laboratories to monitor and report


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