A-154 Reduction in Turnaround Time Achieved by Simplifying Hematology Middleware Rules

Abstract Background Modern hematology analyzers are highly accurate for most peripheral blood samples, however there are still some abnormalities which require manual intervention such as peripheral blood smear review (PBSR) and checking the specimen for clots. This requires valuable laboratory scientist time and can delay result reporting. We reviewed our middleware rules to attempt to streamline our complete blood count with/without differential workflow without sacrificing quality. Methods The institution’s Caresphere Workflow Solution (CWS, Sysmex, Kobe, JP) rules were reviewed and altered to maximize efficiency while maintaining manual steps required to detect clinically significant findings. Changes related to leukocytes included reviewing smears for WBC 0.51-2.00 k/uL once every three days, instead of daily, and raising the threshold for PBSR from 2% immature granulocytes to 5%. For platelets, several rules pertaining to thrombocytopenia and platelet abnormal distribution flags (impedance method) to all automatically reflex to the fluorescent method without holding the result, and checking for clots in thrombocytopenic samples only once every three days instead of daily. Time from receipt in lab to resulting (TAT) was compared between August 2023 (83335 samples) and August 2024 (83500 samples). Staffing was similar for both time periods. Results Overall, TAT was reduced by 58%. The most substantial decrease for routine inpatient results, where TAT was reduced by 34%. Additionally, this resulted in a more even TAT between inpatient STAT (70 min), inpatient routine (81 min), and outpatient (85 min) testing. The manual PBSR rate changed from 11% to 10%. Conclusion Simple rule reductions lessening manual interventions resulted in cutting overall TAT for all specimens by over one half. The reduction in routine impatient TAT could help to better optimize discharges and other hospital functions. Having TAT be more equal between these different specimen types could potentially allow the laboratory to switch to a first-in-first-out flow rather than binning different samples by priority (STAT v. routine). Laboratories should periodically assess their hematology rules to eliminate unnecessary work, especially as hematology analyzers become more sophisticated.