Zarbo R J, Gephardt G N, Howanitz P J
Department of Pathology, Henry Ford Hospital, Detroit, Michigan, USA.
Arch Pathol Lab Med. 1996 Mar;120(3):234-44.
To develop multi-institutional reference databases for intralaboratory timeliness of surgical pathology routine biopsies and complex specimens from the time of specimen accessioning to report completion, and to examine the influence of laboratory characteristics and practices on turnaround time (TAT).
Participants in the Q-Probes quality improvement program of the College of American Pathologists took 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 intralaboratory time interval, performance was compared with the College of American Pathologists' laboratory accreditation standard of 2 working days.
Five hundred twenty-five surgical pathology laboratories responded to the study of routine biopsies, and 489 laboratories responded to the study of complex specimens. Participants were mainly located in the United States, but there were respondents from Canada, Australia, New Zealand, and Hong Kong as well.
In the first study, evaluation of 15 725 biopsy cases showed that the cumulative aggregate 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 participant's data revealed that all reports were completed by the second working day in 90% of the laboratories and by the third working day in 95% of laboratories. Factors that significantly contributed to increased report TAT included larger institutional size, a greater number of surgical pathologists, greater annual surgical pathology volume processed, technical processing resulting in delayed slide availability, pathology practices that integrated residency training, and reduced staffing levels of histotechnologists/technicians and transcriptionists. Shorter TATs were achieved in those institutions that had previously established a TAT goal for routine biopsy specimens. In the second study of 14 298 aggregate complex specimen cases, 68% required routine processing and 32% required special handling. Overall, 56% of all complex specimen reports were processed and completed in 1 working day, 81% in 2 working days, 91% in 3 working days, and 95% in 4 working days. On average, the percentage of cases processed and reports signed out in 2 working days or less was 80% for all complex specimen cases, 90% for routine cases, and 60% for special-handling cases. The mean of all participants' 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. Several factors were associated with increased report TAT: institutional occupied bedsize greater than 450, routine responsibility for gross dissection assigned to residents only, earliest availability of slides after 12 pm, resident involvement in sign-out, interposing a day between availability of slides and final slide sign-out for resident education purposes, and a greater number of surgical pathologists.
We have documented that for the majority of routine cases, the College of American Pathologists Laboratory Accreditation Program's TAT standard of report completion time within 2 working days for the intralaboratory component of TAT is a reasonable goal. This standard was successfully met by participants in 95% of routine biopsy cases and 91% of routine complex specimens. Special-handling procedures for complex specimens contributed, on average, an additional delay of 1.3 days. To our knowledge these are the first systematic studies to describe timeliness from the time of specimen accessioning to report completion for surgical pathology specimens, and they may serve as reference databases for benchm
建立多机构参考数据库，用于记录手术病理常规活检及复杂标本从标本接收至报告完成的实验室内部及时性，并研究实验室特征和操作对周转时间（TAT）的影响。
美国病理学家学会Q-Probes质量改进项目的参与者参与了两项独立研究，第一项研究于1992年和1993年进行，第二项研究于1993年和1994年进行。每位参与者在每项研究中跟踪30例常规活检和30例复杂标本从标本接收到报告完成的天数。基于此实验室内部时间间隔，将表现与美国病理学家学会2个工作日的实验室认可标准进行比较。
525个手术病理实验室回应了常规活检研究，489个实验室回应了复杂标本研究。参与者主要位于美国，但也有来自加拿大、澳大利亚、新西兰和香港的回应者。
在第一项研究中,对15725例活检病例的评估显示，从标本接收到报告完成，常规活检病例在1个工作日内处理的累积总百分比为79%，在2个工作日内为95%，在3个工作日内为98%。个别参与者的数据显示，90%的实验室在第二个工作日完成所有报告，95%的实验室在第三个工作日完成。导致报告周转时间增加的显著因素包括机构规模较大、手术病理学家数量较多、每年处理的手术病理量较大、技术处理导致玻片可用性延迟、整合住院医师培训的病理操作，以及组织技术人员/技术员和转录员的人员配备水平降低。在那些之前为常规活检标本设定周转时间目标的机构中，周转时间较短。在对14298例复杂标本病例的第二项研究中，68%需要常规处理，32%需要特殊处理。总体而言，所有复杂标本报告的56%在1个工作日内处理并完成，81%在2个工作日内，91%在3个工作日内，95%在4个工作日内。平均而言，所有复杂标本病例在2个工作日或更短时间内处理并签署报告的百分比为80%，常规病例为90%，特殊处理病例为60%。所有参与者复杂标本的中位周转时间平均值为1.5天（范围0 - 5天），需要常规处理的病例为1.3天（范围0 - 5天），需要特殊处理的病例为2.6天（范围0 - 13.
