Turn around time in pathology research
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turnaround time pathology laboratory quality
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turnaround time pathology laboratory benchmarks quality improvement 2024 2025
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PMID: 36225468
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https://pmc.ncbi.nlm.nih.gov/articles/PMC11486360
Here is a thorough overview of Turn-Around Time (TAT) in Pathology Research:
Turn-Around Time (TAT) in Pathology and Laboratory Medicine
Definition
TAT is the elapsed time from a defined start point (test ordering, specimen collection, or specimen receipt in the lab) to a defined end point (result reported or delivered to the clinician). The exact definition matters for measurement - the Cureus review by Dawande et al. (2022) defines it as "time from receipt of the sample in the laboratory to final delivery or dispatch of the report."
The definition can shift based on the starting point:
- Order to result (total TAT) - clinician perspective
- Specimen receipt to report (intra-laboratory / analytic TAT) - lab perspective
- Result to clinical action (post-analytical TAT)
The Three Phases of TAT
| Phase | Description | Typical Time Wasters |
|---|---|---|
| Pre-analytical | Order to specimen arriving in lab | Mislabeling, transport delays, improper fixation |
| Analytical | Specimen accession to result/report generated | Processing, staining, IHC, pathologist review |
| Post-analytical | Report release to action taken | Transcription errors, delayed sign-off, notification failures |
Research shows that most delays occur in the pre-analytical phase (est. 46-70% of total TAT errors). The lean methodology systematic review (PMC11486360) found lean-based interventions reduced intra-laboratory TAT by 4 to 6,137 minutes depending on context.
Benchmarks by Specimen/Test Type
Frozen Sections (Intraoperative)
The College of American Pathologists (CAP) Accreditation Checklist defines the critical interval as 15 minutes from specimen receipt by pathologist to slide availability. Benchmark data from 700 institutions across North America shows:
| Hospital Bed Size | 50th Percentile (min) | 90th Percentile (min) |
|---|---|---|
| <150 beds | 17 | 25 |
| 151-300 beds | 18 | 26 |
| >300 beds | 20 | 30 |
| All institutions | 18 | 26 |
An outlier rate of ~8.3% aggregate and ~30% institutional was observed (source: Novis Consulting benchmarking data).
Surgical/Anatomic Pathology - Complex Specimens (CPT 88307/88309)
Benchmark recommendations for percent of reports completed:
| Working Day | Overall | Routine Cases | Special Handling |
|---|---|---|---|
| Day 1 | 56% | 73% | 21% |
| Day 2 | 81% | 91% | 58% |
| Day 3 | 91% | 97% | 78% |
| Day 4 | 95% | 99% | 88% |
Target: >90% of routine cases reported within 2 working days.
Slide availability time significantly affects TAT - labs with slides ready before 10 AM achieve ~94-95% of routine reports within 2 working days, vs. ~78% when slides are ready after noon.
Clinical/Chemical Pathology (STAT vs Routine)
- STAT tests (e.g., troponin, blood gas, CBC): target TAT typically 1 hour or less from order
- Routine chemistry panels: 4-24 hours
- Microbiology cultures: 24-72 hours (blood cultures up to 5 days)
- Molecular/NGS-based testing (e.g., for NSCLC companion diagnostics): 5-14 working days; a major current challenge per Hofman et al. (2024)
Factors That Affect TAT
Factors that shorten TAT:
- On-site histology processing and pathologist evaluation
- Slides available early (before 10 AM)
- Telephone/critical value reporting
- Sunday transcription
- Increased pathologist/histotech staffing
- Automation and LIS (Laboratory Information System) integration
Factors that lengthen TAT:
- Small hospital size (limited staff/resources)
- Delayed report sign-off
- Off-site histology services
- Part-time clinicians (slow to retrieve reports)
- Special handling requirements (decalcification, fat clearing, IHC, special stains)
- Manual data processing
Quality Improvement Methods
- Lean methodology - eliminating non-value-added steps (the systematic review from PMC11486360 found consistent TAT reductions across multiple lab settings using lean)
- Lean Six Sigma - combines lean waste reduction with Six Sigma statistical control; used to reduce emergency lab TAT by 12-152 minutes in multiple studies
- Digital Shadow / Real-time LIS monitoring - a 2025 study using Pareto analysis + QCC (Quality Control Circle) identified 5 root causes and achieved consistent TAT reduction through real-time dashboards (PMC12409014)
- Automation - automated pre-analytical aliquoting and specimen routing; molecular platforms with faster nucleic acid extraction significantly reduce analytical TAT
- Point-of-Care Testing (POCT) - moves testing closer to the patient, dramatically cutting total TAT for selected tests
TAT as a Quality/Accreditation Metric
- CAP, JCAHO/Joint Commission, and ISO 15189 all require laboratories to define, monitor, and report TAT as part of quality management
- TAT is a key performance indicator (KPI) reviewed in hospital performance meetings
- Repeated TAT outliers can trigger accreditation reviews
- Clinician satisfaction surveys consistently rank TAT as the top concern about lab services
Research Gaps and Current Focus Areas
- Defining TAT for whole genome sequencing in clinical microbiology (EUCAST 2026 update, PMID 42142806)
- TAT for molecular pathology in lung cancer (companion diagnostics) remains a major bottleneck for timely treatment initiation
- Standardization of TAT definitions across institutions for meaningful benchmarking
- Integration of AI/digital pathology to reduce sign-out time
Summary: TAT is the single most-cited metric of laboratory performance. It spans pre-analytical, analytical, and post-analytical phases. Published benchmarks (primarily from CAP Q-Probes studies and David Novis's work) set targets of ~18 minutes for frozen sections and >90% of routine surgical pathology reports within 2 working days. Lean and Six Sigma remain the best-evidenced improvement strategies, with newer approaches incorporating real-time digital monitoring.
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