Application of Lean System for Turnaround Time Reduction of HbA1c Analysis in Chonburi Hospital

Abstract

             Hemoglobin A1c (HbA1c) is an efficient test to monitor diabetic patients. The problem found in the Medical Technology Department of Chonburi Hospital was HbA1c results could not be reported in guaranteed turnaround time (TAT). This prospective study aimed to apply a Lean system to reduce delayed TAT for HbA1c assay. The causes and related factors that affected reporting HbA1c results with delayed TAT of more than 60 minutes were analyzed by considering testing processes and steps comprising pre-analytic, analytic, and post-analytic classified by three types of flag errors; Sample S., <test and >test and duration time of sample submitted with delayed TAT. The data obtained  were compared between before and after the Lean implementation. The results revealed that before and after applying the Lean system, delayed TAT of 179 cases (1.11%) and 140 cases (1.02%), were found among 16,012 and 13,721 samples, respectively. The most common periods of delayed TAT were between 04:01-10: 00 a.m., which were statistically significantly different compared with other periods (p < 0.05). When the process of HbA1c assay was classified by flag errors, the median time of pre-analytic, analytic, and post-analytic processes after applying the Lean system were significantly reduced, especially in the flag error type >test (p < 0.05). After the Lean implementation, TAT of the samples in the case of >test were significantly decreased (p < 0.05), especially pre- and post-analytic. In conclusion, after applying the Lean system, the median delayed TAT and number of samples in flag error type >test reduced in both pre-and post-analytic processes of HbA1c analysis. This study shows that the Lean system can be used as a tool to improve the efficiency of HbA1c analysis.