College of American Pathologists
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  PAP/NGC Program Review


cap today

August 2003
Special Section

Nongyn turnaround time-applying the requirement to your lab

Jonathan H. Hughes, MD, PhD

In the August 2002 issue of CAP TODAY, the Laboratory Accreditation Program checklist's new guideline for the turnaround time of nongynecologic cytology specimens was presented and discussed. The checklist question reads as follows: 0YP.06532 Phase I: Are 90 percent of reports on routine nongynecologic cytology cases completed within two working days of receipt by the laboratory performing the evaluation?

This question was added to underscore the importance of turnaround time as a measure of laboratory service quality and because the CAP believes that a goal of two working days TAT for routine nongynecologic cytology specimens is reasonable for most laboratories.

Since we last discussed this topic in August of last year, the Nongynecologic Working Group has received inquiries from a number of laboratories requesting further explanation and clarification of the new guideline. Most of these inquiries have come from smaller laboratories that use reference labs for screening or final diagnosis, and for which a two-day TAT is not possible. The CAP recognizes that there is considerable heterogeneity in the size and practice characteristics of the laboratories participating in the accreditation program. Because of this diversity, the recommended TAT of two working days is meant to serve as a guideline only. Each laboratory is responsible for defining its own TAT parameters that are reasonable for the types of specimens processed and that take into account limiting factors such as the use of reference laboratories. In many instances, a laboratory may be able to set a TAT of two working days for a subset of routine specimens, and then provide reasonable justification for specimens that require longer times because of special circumstances, such as special stains, flow cytometry, or reference laboratory processing/screening.

As is the case with all of the accreditation program checklist questions, the new nongyn cytology TAT requirement is meant to serve as a guideline for maximizing the quality of pathology services and patient care within the practical constraints of the individual laboratory. Each laboratory should monitor TAT continually and carefully, be able to show it has an ongoing quality assurance plan for minimizing TAT, and be able to justify those cases for which a two-day TAT is not achievable.

Dr. Hughes, a member of the Nongynecologic Working Group of the CAP Cytopathology Committee, is with Laboratory Medicine Consultants, Ltd., Las Vegas.