Map tuberculosis samples from arrival to result
A TB laboratory sample flow map turns a fragmented collection-to-report pathway into a visible sequence of people, specimens, decisions and handoffs. It is especially useful for tuberculosis testing, where sputum quality, transport conditions, laboratory queues and result communication can each extend turnaround time. Mapping the full specimen pathway shows where delay occurs rather than leaving teams to blame the final reporting step.
The GLI Quality Tool supports this work through a four-phase roadmap built around twelve Quality Systems Essentials. Relevant areas include laboratory safety, personnel, equipment, documentation, assessment and continual improvement. A flow map is therefore more than a drawing: it connects daily operations with policies, records and improvement decisions across a public health laboratory.
Australian services add important context. Requests may come through public respiratory clinics, major public hospitals, general practices or private pathology collection and courier services, while major reference laboratory networks operate in Sydney and Melbourne. TB is a notifiable disease under state and territory public health legislation, and suspected or confirmed cases must be reported through the relevant health authority. The specimen pathway should support this process while keeping laboratory result dispatch distinct from formal disease notification.
Begin with a current-state map of one representative request, such as sputum for smear, nucleic acid amplification testing and culture. Include collection, transport, receipt, accessioning, testing, review, communication and any recollection or referral loop. Compare elapsed time at each step with staff touch time; this reveals queues, duplicate checks and invisible handoffs that an average turnaround time can conceal.
Set the scope and capture the current state
Define the boundary first: a patient arrives at a collection point, a specimen leaves that point, and the authorised result is dispatched after verification. Include courier movements, specimen receipt, barcode reconciliation, request completeness, bench work, instrument queues, quality-control holds, result authorisation, clinical communication and the close-out of notifications. Keep clinical triage outside the map unless it directly delays specimen collection or laboratory acceptance.
Walk the pathway with the people who perform each handoff and note what can go wrong: a missing request, an unlabeled container, delayed transport, rejected sputum, a failed test, an absent authoriser or an electronic result that is technically complete but not communicated. Use the GLI Tool’s phase-specific checklists to compare what should be happening with what is actually observed. This keeps the map anchored to documented laboratory processes.
Record timestamps at meaningful events rather than relying on recollection. Useful fields include request time, collection time, dispatch from the collection site, laboratory receipt, accessioning, test start, test completion, validation and result release. If the laboratory information system does not capture a handoff, agree on a simple manual entry for the pilot. A slightly imperfect map used weekly is more valuable than a perfect drawing that never changes.
Build a swimlane map of every handoff
Place each role in its own lane: patient and clinician, collection staff, courier, laboratory reception, accessioning, bench staff, instrument supervisor, authorising clinician and result dispatcher. Add separate lanes for referral laboratories, public health notification and quality control when they own a decision. Horizontal arrows should show specimen movement; vertical arrows should show information or authorisation. Circles can flag waits, while diamonds identify decisions such as rejection, recollection, repeat testing or referral.
Describe the normal path in operational language. At specimen arrival, confirm patient identifiers, collection details, container count and transport condition. At accessioning, reconcile the barcode with the request, assess volume and quality, and assign prioritisation rules. Testing may include smear microscopy, a nucleic acid assay, culture with phenotypic drug susceptibility testing, or referral to another laboratory. Each result then moves through technical verification, authorised review, clinical notification and secure dispatch through the laboratory information system or approved electronic channel.
Give equal attention to exceptions. Record where temperature-controlled or triple-layered packaging is checked, how contaminated or insufficient sputum is handled, and who contacts the ward when a specimen cannot be processed. Instrument downtime, absent staff, incomplete requests and pending confirmatory tests can all create a hidden queue. The map should name the authorised decision-maker for each exception, the expected response time and the record that proves the action occurred.
Measure queues and test likely bottlenecks
Separate necessary waiting from avoidable delay. A culture may correctly require several days, but a specimen waiting two days for accessioning is not the same as a negative smear result. Calculate turnaround time for each stage and for the complete journey, then compare them with local agreed targets. Use median and percentile values, especially when a few urgent or interstate referrals would distort a simple average.
| Journey stage | Common current-state pattern | Target-state indicator |
|---|---|---|
| Collection and transport | Courier waits are inferred from receipt time | Collection, dispatch and receipt times are traceable |
| Accessioning | Requests or barcodes are reconciled manually | Specimen status and next action are visible |
| Testing | Batches form behind analyser or staffing limits | Queue age, downtime and workload are reviewed daily |
| Authorisation | Results wait for an unavailable reviewer | Backup authorisation has a defined trigger |
| Dispatch | Completion in the system is treated as communication | Receipt by the authorised requester is confirmed |
Validate the map against several cases, including a fast negative result, a multi-day culture, a rejected specimen and an interstate referral. In metropolitan Sydney or Melbourne, courier and internal queues may dominate; in places such as Alice Springs or Darwin, long-distance transport, flight schedules and extreme heat can add days. Compare like with like, then ask the team whether every delay is clinically necessary, policy-required or simply uncontrolled.
Turn findings into a practical improvement cycle
Prioritise one or two bottlenecks using impact, patient safety and feasibility. A queue of 40 specimens before accessioning may justify a second receiving position; a two-minute duplicate entry may be removed through a controlled form change. Name an owner for each action, define the expected reduction, and retain before-and-after turnaround data so that improvement is visible to laboratory leadership and partners.
- Choose a high-volume pathway: Start with routine sputum testing and appoint a named owner for the current-state map.
- Make waiting visible: Record queue age at accessioning, testing and authorisation, with an escalation threshold for aged samples.
- Review performance together: Use a short daily huddle to move priority specimens and discuss one recurring failure point.
- Test and measure: Make one controlled change, monitor quality and turnaround time for four weeks, then adjust or adopt it.
Check the change against relevant Quality Systems Essentials, including personnel competence, equipment maintenance, document control and laboratory safety. A faster route that weakens result verification is not an improvement. The GLI Tool’s continual improvement resources can support review of the evidence, corrective action and the next small test. Keep the scope narrow enough for the team to sustain during routine diagnostic work.
Make the map part of routine quality management
Review the map after each improvement, when workflows change or when staffing, courier arrangements or testing platforms shift. Keep a dated version, mark what changed and show whether queue time, specimen quality, errors or notification performance improved. Feed recurrent bottlenecks into the laboratory’s corrective action process, document the decision, and assign a review date. This turns a current-state drawing into evidence that can support NATA accreditation, where applicable, and management review.
Begin with the next high-volume specimen pathway: arrange a 30-minute walk-through with reception, bench, courier and clinical stakeholders, then display the draft where staff already handover work. Choose one timestamp that is currently missing and add it for two weeks. Assign an owner, publish the first queue measure and schedule the review before the team disperses. The pathway map becomes useful when it is visible, owned and changed in response to evidence.