Background: We describe a general strategy for optimizing the
availability of 'stat' out-of-hours laboratory tests to the particular clinical needs
of health care institutions. Methods: We initially introduced a
consensus menu of 'stat' tests and prospectively monitored for 5 years all additional
requests for 'stat' clinical biochemistry tests in a metropolitan tertiary referral
university teaching hospital. Laboratory staff triaged 'stat' requests, and clinical
biochemistry consultants reviewed requests not already performed routinely. The
frequency of these requests was monitored on a Shewhart 'c' control chart. A quality
system certified to ISO 9001 was used to assure laboratory compliance with
procedures. Various interventions were tested using the Shewhart 'c' control chart to
monitor their effectiveness. Results: Matching the timing of analytical
assays with the time of sample collection had no significant effect on the number of
'stat' requests. Implementation of a hospital-wide laboratory information system also
had no significant effect on the number of 'stat' requests. The most effective
strategy consisted of optimization of the test menu to match request patterns,
combined with the introduction of a laboratory quality system.
Conclusions: Within our institution, this strategy resulted in a
sevenfold reduction in 'stat' requests, from one per 2200 specimens to fewer than one
per 32 000 specimens.
