GLI GLI Quality Tool
GLI Quality Tool — Version 2.0

Implementing a TB laboratory turnaround target table

To implement a TB lab turn-around time target table for clinical decision making, start with the clinical decision each result must support. Suspected tuberculosis (TB) can prompt infection-control measures, clinical review, referral, public health notification or treatment changes before a complete culture result is available. The table therefore needs to connect specimen receipt, testing, result authorisation and clinical communication while distinguishing preliminary findings from final reports.

Australia’s geography makes a simple laboratory average misleading. Metropolitan services in Melbourne, Sydney and other capital cities may receive specimens directly, while public laboratories and clinics in regional or remote Western Australia, the Northern Territory and northern Queensland often depend on courier runs and sometimes aircraft transfer. A single target can conceal where delay occurred: specimen transit, accessioning, testing, authorisation, electronic release or handover to the treating team.

Used well, the target table is a quality-management instrument rather than a motivational poster. It establishes valid denominators, assigned responsibility and a review cycle, so speed is assessed alongside result quality and clinical usefulness. This matters when clinicians must act on a rapid nucleic acid amplification test (NAAT) while mycobacterial culture and drug-susceptibility testing (DST) remain in progress.

Define the clocks before setting targets

Adopt one primary definition for laboratory turnaround time (TAT): elapsed time from receipt and accessioning of an acceptable specimen to an authorised result being available to the requester. For urgent pathways, record elapsed hours; for culture and DST, calendar days may be more meaningful. State whether weekends and public holidays count, define the after-hours service and record specimen rejection, recollection and referral-laboratory receipt as separate events.

Some results have two legitimate time points. A preliminary NAAT result may be released within the clinical day, while the final report later incorporates culture confirmation, contamination checks or DST. Give each a separate row, target and escalation rule, and state whether the clock stops at preliminary reporting or continues to final authorisation. A final culture target without an interim update can leave a clinician waiting without knowing whether testing is progressing.

Measure two related outcomes when they are available: laboratory TAT, ending when the result is released in the laboratory information system, and clinical communication time, ending when the authorised result reaches the decision-maker. They are not interchangeable. A result released electronically but never seen, or a critical finding held in an after-hours telephone queue, has not yet supported the intended care. Define how access failures, failed logins and unclaimed calls are handled.

Build the table around decisions and test pathways

The target table should be usable at a glance. Include the test and result status, specimen pathway, target start and stop points, clinical priority, routine target, warning threshold, escalation action, accountable role, data source and review date. Separate tests performed on-site from those sent to another laboratory. Add the decision supported by the result, such as infection-control review, further specimen collection or microbiology advice.

A starter structure might look like this, subject to local validation:

Service and result status Illustrative target Action when the target is at risk or missed
Urgent respiratory NAAT, preliminary result Same clinical day from receipt during the agreed testing window Notify the requester and infection-control team, then review prioritisation, instrument status and specimen quality
Acid-fast bacilli microscopy Same or next working day, according to clinical urgency Escalate the accessioned specimen for review and communicate any revised reporting time
Mycobacterial culture, interim and final Interim update at an agreed interval; final result within a locally validated maximum Notify the requester of the revised date and investigate pre-analytical or processing delays
DST result Target aligned with confirmed growth, referral transport and the treatment decision Alert clinical microbiology and the treating team when the result cannot meet the agreed schedule

Targets should be set from clinical need and demonstrated process capability, not copied from another jurisdiction. A same-day target may be realistic for an on-site NAAT and unrealistic for a specimen travelling to a reference laboratory. When testing is outsourced interstate, include dispatch, referral receipt and report return in the pathway, and name who owns each stop. The treating team should know whether an apparently delayed result is awaiting transport, culture growth, DST referral or clinical review.

Connect the table to the laboratory quality management system. The GLI Quality Tool provides a four-phase roadmap organised around 12 Quality Systems Essentials, with practical guidance on safety, personnel, equipment, documentation, assessment and continual improvement. Use the table as part of documented quality improvement rather than a separate spreadsheet that can drift from laboratory procedures, and link relevant indicators to the wider quality system.

Recommendations for a reliable target table

A strong table makes responsibility and escalation explicit before performance is poor:

The laboratory quality manager should approve the table after consultation with requesting clinicians, infection-control staff and the public health team, then manage it through standard operating procedures, competency assessment and documented review. In Australia, retaining the approved version, validation evidence and review records in the quality management system also supports NATA accreditation against ISO 15189. Keep the wording operational: “authorised result available in the laboratory information system” is more testable than “result reported promptly”. Confirm who receives and acknowledges urgent notifications, including after-hours and weekend arrangements.

Monitor performance without gaming the clock

Use a recent baseline to set initial targets, then report the percentage within target, median turnaround time and 90th percentile for each row. Show the number of specimens behind every percentage and keep urgent and routine work separate. Do not remove late specimens, rejected samples or send-out tests without a predefined rule; display exclusions and reasons beside the result. Where a regional courier causes delays, report transport time separately from laboratory processing so the team can direct corrective action to the right process.

A run chart or control chart can show whether a service is stable, improving or experiencing unusual delay. The GLI resource on control chart guidance explains how to monitor TB laboratory test performance over time. Plot weekly or monthly points only when the reporting interval is meaningful, interpret shifts with laboratory staff, and avoid changing limits merely to make variation disappear.

At a regular multidisciplinary review, examine every material breach and recurring delay by cause: courier timing, equipment downtime, unavailable staff, queue bottlenecks, result-authorisation delays, invalid tests or interface failures. Record the corrective action, owner and due date in the quality system, then check whether the next period improved. Pair turnaround indicators with quality measures such as invalid rates, contamination, discrepant results and critical-notification completion; a faster but less reliable process is not an improvement.

Turn performance into clinical action

Embed the agreed action in laboratory information system comments, request forms and escalation scripts. For example, an authorised positive NAAT should trigger the locally agreed infection-control and requesting-clinician notifications, while a missed microscopy target should prompt confirmation that the specimen was reviewed. The laboratory communicates the finding; a qualified clinician interprets it with symptoms, imaging, exposure history and prior results. A target is therefore complete only when the intended decision-maker has the correct result at the right time.

Communication arrangements are particularly important in Australia, where public and private pathology services, public hospitals and after-hours services may all touch one patient episode. Define one secure route for urgent findings and one for routine reports, test them at handover, and document the Privacy Act 1974 and applicable state or territory Health Records Act requirements. Keep sensitive clinical details out of ordinary SMS messages and use approved electronic channels or telephone processes.

For Aboriginal and Torres Strait Islander patients, especially those receiving care through Aboriginal Community Controlled Health Organisations or remote clinics, coordination should include local clinicians, community workers and professional interpreters where needed. Test whether results can be accessed and discussed in a culturally safe way, not merely whether the analyser completed its run. State and territory public health teams should also receive notification through the legally required pathway, with the target table recording completion rather than assuming transmission.

Start this month with a one-page pilot for the highest-volume decision pathway, such as respiratory NAAT and AFB microscopy. Name the laboratory and clinical owners, load the agreed indicators, and review the first month of results at the laboratory quality meeting; expand the table only after the definitions, escalations and data have been tested in practice.