Examining the effect of laboratory turnaround time on hospital performance: a case study of Nakasero Hospital in Uganda

Abstract

Laboratory turnaround time (TAT) is a critical indicator of healthcare service delivery because it influences the timeliness of diagnosis, treatment initiation, and overall hospital performance. In low- and middle-income countries (LMICs), delays in laboratory processes continue to pose significant challenges to healthcare systems by contributing to prolonged hospital stays, reduced service efficiency, increased costs of care, and suboptimal patient outcomes. Despite the importance of laboratory services, limited empirical evidence exists on the effect of laboratory turnaround time on hospital performance within private tertiary healthcare facilities in Uganda. This study examined the effect of laboratory turnaround time on clinical efficiency, service quality and financial performance at Nakasero Hospital in Kampala, Uganda. The study was guided by Lean Management Theory and the Theory of Constraints and adopted a Sequential Explanatory Mixed-Methods Research Design. Quantitative data were collected through a retrospective review of 217 eligible patient records extracted from the Laboratory Information System (LIS), Electronic Medical Records (EMR) and hospital billing records. Qualitative and perceptual data were collected through a survey of 60 healthcare workers comprising clinicians, nurses and laboratory personnel. Quantitative data were analyzed using descriptive statistics, Pearson correlation analysis, multiple linear regression and analysis of variance, while qualitative data were analyzed thematically. The mean total laboratory turnaround time was 198.4 ± 112.5 minutes. The analytical phase accounted for the largest proportion of intra-laboratory processing time (53.0%). Healthcare workers identified equipment functionality (M=2.85±0.88) and staffing adequacy (M=2.90±0.82) as key constraints. Multiple regression analysis showed that equipment functionality (β=-0.412, p<0.001) and staffing adequacy (β=-0.385, p=0.002) were significant predictors of TAT, explaining 54.2% of its variance (Adjusted R²=0.542). Total TAT was positively associated with length of stay (r=0.48, p<0.001) and increased cost of care (β=0.406, p<0.001), while negatively affecting adherence to clinical protocols (β=-0.584, p<0.001). Laboratory TAT significantly influences clinical efficiency, service quality, and financial performance. The study recommends investment in laboratory automation, strengthened equipment maintenance, improved staffing levels, enhanced laboratory information system integration and implementation of lean workflow strategies to reduce bottlenecks and improve hospital performance.