Test turnaround Time for Complete Blood Cell Count using Delta and Panic Value Checks and the Q-flag Limit

Test turnaround time (TAT) is the lead time from reception to reporting. In the complete blood cell count (CBC), 4 units of the XE-2100 (Sysmex Corp., Japan) processed around 80% of quantity, 1 unit of the LH-780 (Beckman-Coulter Incorp., USA) processed around 10% and 1 unit of ADVIA-2120 (Siemens AG, Munich, Germany) processed around 10%. We analyzed the change in the TAT for the CBC for over 7 years, from January of 2005 to December of 2011. The delta check made alterations of delta to WBC, hemoglobin, hematocrit, platelet and metamyelocyte, however, did not made them to band neutrophil, eosinophil, basophil and monocyte. The panic value check made alterations of panic value to hemoglobin, hematocrit, platelet and monocyte. In the criteria of currently slide review, LH-780 and ADVI-2120 analyzers prepared suspect flags of "Blast, Imm NE2, Immature granulocyte, Imm NE1, Left shift, Variant lymphocyte, Atypical lymphocyte, Platelet clumps and NRBC". The New slide review in the XE-2100 analyzer altered the preparations of a smear slide more than a "Platelet clumps flag(${\geq}200unit$), a single flag excluding the "Platelet clumps flag (${\geq}250unit$) and a multiple flag (${\geq}200unit$)". Also, below the 240 unit, medical technologists prepared manual slides selectively according to their evaluations. The automatic reporting rate was 33.4% without alterations, whereas it was 41.0% without alterations, and was thus improved by 7.6%. The slide review rate was 15.2% before using the Q-flag limit, whereas it was 12.1% for a reduce 3.1%. TAT was 45 minutes without the creation alterations of the delta and panic value checks, whereas it was 35 minutes after making alterations of the delta and panic value checks and thus was shortened by 10 minutes. We came to the conclusion that the establishment and operation of delta and panic value checks and slide review criteria suitable for laboratory environment can reduce unnecessary smear slides, re-checking, re-sampling, re-testing, telephone inquiries and concentrated workloads during specific times of the day.