A-214 Impact of Autoverification of Laboratory Tests on Turnaround Time. Biochemical Analysis in a Large-scale Laboratory

Abstract Background Autoverification of tests consists of the automated release of results, eliminating manual intervention and ensuring greater standardization and agility in the process, with a consequent reduction in total turnaround time (TAT), and is a promising strategy for optimizing laboratory routine. According to the guidelines of the Clinical and Laboratory Standards Institute (CLSI), the criteria for autoverification are flexible and can be adapted to the specific needs of each laboratory. The aim of this study was to describe the process of selecting criteria for implementing autoverification for biochemical analysis and to demonstrate the impact obtained. Methods All the criteria and premises included in the algorithms for defining the automatic release rules applied in this study were based on the recommendations described in document AUTO10-A, CLSI. For the first rule, inserted into the middleware and in the Laboratory Information System (LIS), the RCV delta test was adopted. To calculate this value, the RCV (Reference Change Value) formula was used, where RCV = 21/2 * Z * [CVA2 + CVI2]1/2. The CVa (coefficient of analytical variation) was calculated from the means of the internal quality control of twenty-five hospital laboratory units served. The CVi (coefficient of intra-individual variation) was obtained from the EuBIVAS (European Biological Variation Study) database using a Z-significance level of 95%. Prior to calculation, outliers were removed to avoid a prolonged final mean CVi resulting in a higher RCV value and the possibility of inappropriate publication of results. The RCV delta check was applied to tests with a prior result within a period of up to three days. For patients with no prior results, a second rule was established using reference intervals. Twenty-two tests were selected: uric acid, albumin, amylase, bilirubin, calcium, creatine kinase, creatine kinase MB fraction, chloride, creatinine, lactic dehydrogenase, alkaline phosphatase, phosphorus, gamma glutamyl transferase, glucose, magnesium, C-reactive protein, potassium, total protein, sodium, glutamic oxaloacetic transaminase, glutamic pyruvic transaminase, and urea. These tests were performed on dry biochemistry equipment (Vitros®). The TAT parameters and the percentage of automated release tests were calculated using the LIS database for a six-month period before and after implementation for comparative analysis, considering the sample screening stage until the result is released. The proportion of automatically released tests compared to manually released tests was also evaluated. Results Following the implementation of automatic release, approximately 72.5% of a total of 3,457,231 tests were automatically released. A preliminary analysis showed a reduction in TAT of approximately 19.5% in test release time in the comparative analysis. In general, all tests showed a reduction in TAT. The lactic dehydrogenase showed the greatest reduction, approximately 30.4%. Conclusion The implementation of auto-verification optimized the results release process, allowing an improvement in the performance of the release time indicator. This improvement directly contributed to the quality of care and operational efficiency by reducing the TAT of biochemical tests, which represent the largest volume in hospital laboratory units.