Improvement in laboratory test turnaround times for inpatients following move to hub and spoke model of delivery

OBJECTIVES: The relative merits of hub and spoke models of service delivery are often debated, but accessing data on how they may benefit service delivery can be difficult, and may hinder the adoption of a model which can benefit the health community. Our aim was to provide objective data that would either support or refute one potential benefit of service redesign, namely the effect on turnaround times within the acute hospital. DESIGN AND METHODS: Data on turnaround times for sequential requests containing creatinine as a request item received from inpatient locations at two acute hospitals were extracted from the laboratory computer system. Monthly data was collected for a period of 5 months prior to and the same 5 month period following the service redesign. Data was subjected to statistical process control (SPC) analysis. RESULTS: There was a statistically significant reduction (P<0.05) in the average turnaround time of at least 29% for routine requests and 22% for urgent requests, accompanied by a statistically significant reduction (P<0.05) in upper control limits of least 46% – improving the predictability of result availability and reducing the 95% confidence interval for turnaround times. CONCLUSIONS: Adoption of a “hub and spoke” model has the potential to support laboratories in improving both urgent and non-urgent turnaround times in a cost-efficient manner within acute hospitals, and reduce the variability in turnaround time.