Evaluation of Turnaround Time Performance in Hospital Laboratories in Riyadh: A Cross-Sectional Multi-Center Stud

Abstract

Background: Turnaround time (TAT) is a critical quality indicator in clinical laboratory medicine. Prolonged TAT can adversely affect patient outcomes, clinical decision-making, and hospital efficiency. Despite increasing automation and informatics integration in Saudi hospitals, systematic benchmarking data specific to Riyadh remain limited.

Objectives: To evaluate and compare laboratory TAT performance across government, private, and military hospitals in Riyadh; to identify the main phases and root causes of delay; and to propose evidence-based improvement strategies.

Methods: A cross-sectional, multi-center study was conducted across eight hospitals in Riyadh from January to December 2023. A total of 42,750 laboratory requests were analyzed across hematology, clinical chemistry, coagulation, microbiology, immunoassay, and point-of-care testing sections. TAT was measured from specimen collection (order time) to result reporting. Data were extracted from laboratory information systems (LIS) and electronic medical records (EMR). Statistical analysis included descriptive statistics, Kruskal-Wallis and Mann-Whitney U tests, and Pareto analysis of delay causes.

Results: The overall median TAT across all centers was 54 minutes (IQR: 38–82 min). Tertiary government hospitals achieved the shortest median TAT (47 min), significantly lower than secondary government facilities (68 min; p=0.008). Pre-analytical phase delays accounted for 60.5% of total TAT deviations, with specimen recollection being the single most frequent root cause (38.4%). Point-of-care testing consistently met benchmark TATs, while microbiology cultures and chemistry reflexive panels showed the highest rates of target non-compliance (18.3% and 14.7% respectively). Hospitals with integrated LIS-EMR systems demonstrated a 22% reduction in post-analytical delays compared to non-integrated facilities.

Conclusion: TAT performance in Riyadh hospital laboratories is generally satisfactory in tertiary centers but significantly suboptimal in secondary facilities. Pre-analytical process improvement, pneumatic transport systems, and full LIS-EMR integration represent the highest-priority interventions to close the performance gap.