INTRALABORATORY TIMELINESS OF SURGICAL PATHOLOGY REPORTS - RESULTS OF2 COLLEGE-OF-AMERICAN-PATHOLOGISTS Q-PROBES STUDIES OF BIOPSIES AND COMPLEX SPECIMENS

Objective.-To develop multi-institutional reference databases for intr alaboratory timeliness of surgical pathology routine biopsies and comp lex specimens from the time of specimen accessioning to report complet ion, and to examine the influence of laboratory characteristics and pr actices on turnaround time (TAT). Design.-Participants in the Q-Probes quality improvement program of the College of American Pathologists t ook part in two separate studies, the first conducted in 1992 and 1993 and the second in 1993 and 1994. Each participant tracked the number of days from specimen accessioning to report completion for 30 routine biopsies and 30 complex specimens in each study. Based on this intral aboratory time interval, performance was compared with the College of American Pathologists' laboratory accreditation standard of 2 working days. Participants.-Five hundred twenty-five surgical pathology labora tories responded to the study of routine biopsies, and 489 laboratorie s responded to the study of complex specimens. Participants were mainl y located in the United States, but there were respondents from Canada , Australia, New Zealand, and Hong Kong as well. Results.-In the first study, evaluation of 15 725 biopsy cases showed that the cumulative a ggregate percentage of routine biopsy cases processed from the time of specimen accessioning to report completion was 79% by 1 working day, 95% by 2 working days, and 98% by 3 working days. Individual participa nt's data revealed that all reports were completed by the second worki ng day in 90% of the laboratories and by the third working day in 95% of laboratories. Factors that significantly contributed to increased r eport TAT included larger institutional size, a greater number of surg ical pathologists, greater annual surgical pathology volume processed, technical processing resulting in delayed slide availability, patholo gy practices that integrated residency training, and reduced staffing levels of histotechnologists/technicians and transcriptionists. Shorte r TATs were achieved in those institutions that had previously establi shed a TAT goal for routine biopsy specimens. In the second study of 1 4 298 aggregate complex specimen cases, 68% required routine processin g and 32% required special handling. Overall, 56% of all complex speci men reports were processed and completed in 1 working day, 81% in 2 wo rking days, 91% in 3 working days, and 95% in 4 working days. On avera ge, the percentage of cases processed and reports signed out in 2 work ing days or less was 80% for all complex specimen cases, 90% for routi ne cases, and 60% for special-handling cases. The mean of all particip ants' median TATs was 1.5 days (range 0-5 days) for complex specimens, 1.3 days (range 0-5 days) for cases requiring routine handling, and 2 .6 days (range 0-13.5 days) for cases requiring special handling. Seve ral factors were associated with increased report TAT: institutional o ccupied bedsize greater than 450, routine responsibility for gross dis section assigned to residents only, earliest availability of slides af ter 12 PM, resident involvement in sign-out, interposing a day between availability of slides and final slide sign-out for resident educatio n purposes, and a greater number of surgical pathologists. Conclusions .-We have documented that for the majority of routine cases, the Colle ge of American Pathologists Laboratory Accreditation Program's TAT sta ndard of report completion time within 2 working days for the intralab oratory component of TAT is a reasonable goal. This standard was succe ssfully met by participants in 95% of routine biopsy cases and 91% of routine complex specimens. Special-handling procedures for complex spe cimens contributed, on average, an additional delay of 1.3 days. To ou r knowledge these are the first systematic studies to describe timelin ess from the time of specimen accessioning, to report completion for s urgical pathology specimens, and they may serve as reference databases for benchmarking and improvement of laboratory performance.