College of American Pathologists
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  PAP/NGC Program Review


cap today

August 2004
Special Section

Q & A

Q.  We use a combination of manual and location-guided screening in my laboratory. How do I calculate cytotechnologist workload limits in this setting?

A.  Maximum workload limits should be calculated based on the following factors:

  1. Manual versus computer-assisted screening. CLIA regulations specify a 100-slide maximum limit for manual screening in 24 hours over a minimum eight-hour work day. This translates to a maximum screening rate of 12.5 slides per hour for manual screening. The Centers for Medicare and Medicaid Services recently set the maximum workload limit for location-guided screening at 200 slides per day. This limit is equivalent to 25 slides per hour for location-guided screening. All Pap tests count as whole slides. Slides from nongynecologic cases count as whole slides except for concentration and liquid-based techniques that confine the material to less than one-half of the slide surface, which may be counted as one-half slides. Quality control and five-year retrospective rescreens are also included in the workload accounting.
  2. Number of hours spent screening. The maximum workload limit should be prorated based on the total number of hours spent screening, using the 12.5 slides per hour maximum rate for manual screening and 25 slides per hour for computer-assisted screening. This time does not include computer data entry, reporting, and other duties.
  3. Cytotechnologist ability, experience, QC data, etc. It must be emphasized that the maximum workload limits are the maximum allowable by CLIA/CMS and are not to be used as a productivity goal. Each cytotechnologist's workload limit should be carefully determined and individualized based on expertise, time spent screening, and screening method(s) used. Here are a few scenarios to illustrate maximum workload limit calculations in different settings:
    • Cytotechnologist A works in a high-volume laboratory and screens Paps using location-guided screening. She is a highly skilled cytotechnologist with 10 years of experience and has no other duties (no data entry or reporting, no answering phone). Her maximum workload limit is 200 slides per day over eight hours (25 slides/hour). This case scenario is a rare exception. Most cytotechnologists have other duties or have a lower personal workload limit set by the laboratory supervisor and medical director.
    • Cytotechnologist B's laboratory just brought a computerized imaging system in house and is gradually making a transition to computer-assisted screening. She now screens about two hours per day using the computer-assisted device and three hours per day screening Paps manually. She spends the rest of her day doing clerical and cytopreparatory work. Her maximum workload allowed by CLIA is: (2 hrs x 25 slides/hr) + (3 hrs x 12.5 slides/hr)=87.5 slides
    • Cytotechnologist C screens Paps every morning using location-guided screening and screens nongyns in the afternoon. Today he spent four hours screening Paps. Although the maximum limit by CLIA would be 25 x 4=100, his individual maximum screening limit is set a bit lower (20 slides per hour), so his maximum limit is 80 for four hours of screening. This afternoon is busy with several FNAs, each of about 20 slides. With four hours left of screening time at 12.5 slides per hour, he is allowed by CLIA to screen a maximum of 50 slides this afternoon. However, his individual workload limit is less, and he will be permitted to screen a maximum of 35 of the FNA slides, and other cytotechnologists will screen the rest.

Although computer-assisted screening methods afford greater productivity, care should be taken to set reasonable maximum workload limits based on the ability of the individual cytotechnologist, to avoid compromising screening accuracy.

Theresa M. Voytek, MD
Department of Pathology
Hartford (Conn.) Hospital
Margaret H. Neal, MD
KWB Pathology Associates
Tallahassee, Fla.
Members, CAP
Cytopathology Committee