1.2b - Delayed Testing Policy

PRINCIPLE
To notify clinicians and laboratory sites when laboratory analysis may be delayed.

PRIORITY OF TESTS
All tests ordered with the urgency of STAT will be done before any routine tests (scheduled as part of the daily routine). STAT testing should be available within one hour; with the exception of abnormal or suspect results which require additional testing procedures to verify the accuracy of the results prior to result release.  This would include instances where a manual test procedure is indicated by abnormal or suspect automated results.
 
All tests ordered with the urgency of ROUTINE will be performed during the routine operation of the laboratory and will be processed in the order of receipt.  Routine specimens with limited stability may take priority over other routine specimens (e.g., BNP samples).
 
Results will be available on the day of request or processed according to the routine handling of the test in the laboratory.  For example: homocysteine is not performed on a daily basis, but will be performed routinely by the laboratory on the designated day.  Results will be available when the test is completed.
 
The Laboratory Collection Manual located on the VA BHS intranet homepage contains the expected test turnaround times. 
 
PROCEDURE
 
At times laboratory test requests may be minimally delayed due to an instrument malfunction, QC outliers, reagent problems, utility failures or by Computer System scheduled maintenance or crash. 
 
For each major laboratory instrument, P&LMS has back up instrumentation so that the health care provider and referring sites will experience only minimal delays.  P&LMS backup instrumentation is either available at the specific Boston Area Consolidated Lab site (BACL), at the West Roxbury core laboratory, or at another Network Consolidated Lab (NCL) site.
 
In addition to back-up instrumentation at a given site, samples can always be sent via courier service to the core laboratory at West Roxbury, another BACL site, or NCL site for analysis.
 
If testing is unavailable at another BACL site or at another NCL site, specimens will be sent to the laboratory’s reference laboratory for testing.
 
If testing is excessively delayed, all health care providers and referring sites will be notified by electronic Mail (e-mail) or by telephone.  This message will define which tests will be delayed and approximately when the provider can expect results of these tests.
 
The Medical Center has a hospital wide contingency plan, which includes the laboratory and the computer system, in the event of a catastrophic computer system failure or other system failure that could interrupt or delay laboratory testing. The laboratory would revert to its contingency plan in this event and all health care providers and referring sites would be notified by the overhead paging system, email and/or by telephone.  Referral sites would also be notified by email or telephone.