Archives of Pathology & Laboratory Medicine, Jul 8, 2021
Context.-Laboratory managers and medical directors are charged with staffing their clinical labor... more Context.-Laboratory managers and medical directors are charged with staffing their clinical laboratories as efficiently as possible. Objective.-To report and analyze the results of 3 College of American Pathologists Q-Probes studies that surveyed the normative rates of laboratory technical staffing ratios. Design.-Participants in the College of American Pathologists Q-Probes program submitted data on the levels of staffing and test volumes performed in their laboratories in 2014, 2016, and 2019. From these data, we calculated departmental productivity ratios, defined as testing volume per full-time equivalent, and degrees of managerial oversight, defined as the ratio of nonmanagement to management full-time equivalents. Participants completed general questionnaires surveying their hospital and laboratory demographics and practices, the data from which we determined demographic and practice characteristics that were significantly associated with technical staffing ratios. Results.-Sixty-seven, 82, and 79 institutions submitted data for the years 2019, 2016, and 2014, respectively. Technical staffing ratios varied widely among the various laboratory departments within each institution and among different institutions participating in this study. With the exception of cytology departments, productivity and managerial oversight ratios did not significantly change between these 3 studies. In the 2019 study, greater testing volumes were associated with higher productivity ratios. Significant associations between managerial oversight ratios and practice characteristics were not consistent across the 3 studies. Conclusions.-Technical staffing ratios varied widely among the various laboratory departments within each institution and among different institutions participating in this study.
Archives of Pathology & Laboratory Medicine, Jun 24, 2020
Context.-Workflow mapping is a tool used to characterize operational processes throughout most in... more Context.-Workflow mapping is a tool used to characterize operational processes throughout most industries and to identify non-value-added activities. Objective.-To develop a set of workflow mapping tools to compare the sequence and timing of activities, including waiting steps, used by clinical laboratories to process specimens during the preanalytic testing phase. Design.-Laboratories enrolled in this College of American Pathologists Q-Probes study created workflow maps detailing the steps they used to process specimens from the time of sample arrival in the laboratory to the time of sample delivery to chemistry analyzers. Enrollees recorded the sequence and types of steps involved in specimen processing and the time needed to complete each step. Results.-Institution average total specimen processing times (SPTs) and the number of steps required to prepare samples varied widely among institutions. Waiting steps, that is, steps requiring specimens to wait before advancing to the next process step, and specimen centrifugation consumed the greatest amount of processing times for both routine and STAT testing. Routine and STAT testing SPTs were shorter at institutions that used rapid centrifuges to prepare samples. Specimen processes requiring more sample waiting steps and computer entry steps had longer aggregate total process times than those with fewer such steps. Conclusions.-Aggregate specimen processing times may be shortened by reducing the number of steps involving sample waiting and computer entry activities. Rapid centrifugation is likely to reduce overall average institutional SPTs.
Archives of Pathology & Laboratory Medicine, Jul 8, 2021
Context.-Laboratory managers and medical directors are charged with staffing their clinical labor... more Context.-Laboratory managers and medical directors are charged with staffing their clinical laboratories as efficiently as possible. Objective.-To report and analyze the results of 3 College of American Pathologists Q-Probes studies that surveyed the normative rates of laboratory technical staffing ratios. Design.-Participants in the College of American Pathologists Q-Probes program submitted data on the levels of staffing and test volumes performed in their laboratories in 2014, 2016, and 2019. From these data, we calculated departmental productivity ratios, defined as testing volume per full-time equivalent, and degrees of managerial oversight, defined as the ratio of nonmanagement to management full-time equivalents. Participants completed general questionnaires surveying their hospital and laboratory demographics and practices, the data from which we determined demographic and practice characteristics that were significantly associated with technical staffing ratios. Results.-Sixty-seven, 82, and 79 institutions submitted data for the years 2019, 2016, and 2014, respectively. Technical staffing ratios varied widely among the various laboratory departments within each institution and among different institutions participating in this study. With the exception of cytology departments, productivity and managerial oversight ratios did not significantly change between these 3 studies. In the 2019 study, greater testing volumes were associated with higher productivity ratios. Significant associations between managerial oversight ratios and practice characteristics were not consistent across the 3 studies. Conclusions.-Technical staffing ratios varied widely among the various laboratory departments within each institution and among different institutions participating in this study.
Archives of Pathology & Laboratory Medicine, Dec 1, 2020
Note: This article was posted on the Archives Web site as an Early Online Release. Early Online R... more Note: This article was posted on the Archives Web site as an Early Online Release. Early Online Release articles have been peer reviewed, copyedited, and reviewed by the authors. Additional changes or corrections may appear in these articles when they appear in a future print issue of the Archives. Early Online Release articles are citable by using the Digital Object Identifier (DOI), a unique number given to every article.
Archives of Pathology & Laboratory Medicine, Jul 17, 2019
Context.-Knowledge of laboratory staff turnover rates are important to laboratory medical directo... more Context.-Knowledge of laboratory staff turnover rates are important to laboratory medical directors and hospital administrators who are responsible for ensuring adequate staffing of their clinical laboratories. The current turnover rates for laboratory employees are unknown. Objective.-To determine the 3-year average employee turnover rates for clinical laboratory staff and to survey the types of institutional human resource practices that may be associated with lower turnover rates. Design.-We collected data from participating laboratories spanning a 3-year period of 2015-2017, which included the number of full-time equivalent (FTE) staff members that their laboratories employed in several personnel and departmental categories, and the number of laboratory staff FTEs who vacated each of those categories that institutions intended to refill. We calculated the 3-year average turnover rates for all laboratory employees, for several personnel categories, and for major laboratory departmental categories, and assessed the potential associations between 3-year average all laboratory staff turnover rates with institutional human resource practices.
Archives of Pathology & Laboratory Medicine, Nov 16, 2021
Context.-Laboratory directors are tasked with staffing laboratories in a manner that provides ade... more Context.-Laboratory directors are tasked with staffing laboratories in a manner that provides adequate services and maintains economic sustainability. Objective.-To determine the national normative rates of phlebotomy staffing and the types of laboratory operational characteristics that may be associated with the magnitude of those staffing levels. Design.-Study participants provided data on inpatient and outpatient phlebotomy sites, including the numbers of patients receiving phlebotomy services, phlebotomy staff, and billable tests. From these data, we calculated performance indicators including the numbers of phlebotomies/phlebotomy full-time equivalent staff, outpatient phlebotomy visits/full-time equivalent staff, and average outpatient phlebotomy wait times. Participants also completed a survey of their laboratory phlebotomy practices. Results.-This study was conducted during the third quarter of 2017. Forty-two institutions participated in this study, providing eligible results for 40 selected inpatient sites and 70 selected outpatient sites. The ratios for all performance indicators spanned between 3.3-and 142fold. The median average outpatient phlebotomy wait time was 8 minutes. None of the performance indicators were associated with the practice variables that we chose to test. Conclusions.-The distribution of phlebotomy staffing performance indicators among the laboratories participating in this study varied widely, even among those groups performing similar volumes of tests.
Context.— Health care organizations face a challenge of assessing preanalytic competency of blood... more Context.— Health care organizations face a challenge of assessing preanalytic competency of blood collectors/phlebotomists (BC/Ps). Objective.— To pilot a novel methodology for BC/P preanalytic competency assessment and identify potential areas for improvement. Design.— Study participants identified preanalytic errors present in 5 blood collection video vignettes. Submitted error descriptions were categorized and then consolidated into a list of standardized required errors for evaluation. Results.— The correct identification of required error rates across all videos viewed by 447 BC/Ps from 46 institutions ranged from 0.7% to 91.9%. The median phlebotomist score across all 5 videos was 55.9% for 440 eligible blood collectors and ranged between 38.2% (10th percentile) and 70.6% (90th percentile). The median institutional score from 42 eligible institutions was 55.9% (range, 43.3%–65.3% for the 10th to 90th percentiles). There were no significant associations between any laboratory p...
Archives of Pathology & Laboratory Medicine, 2013
Context.—Gynecologic cytopathology is a heavily regulated field, with Clinical Laboratory Improve... more Context.—Gynecologic cytopathology is a heavily regulated field, with Clinical Laboratory Improvement Amendments of 1988 mandating the collection of many quality metrics. There is a lack of consensus regarding methods to collect, monitor, and benchmark these data and how these data should be used in a quality assurance program. Furthermore, the introduction of human papilloma virus testing and proficiency testing has provided more data to monitor.Objective.—To determine good laboratory practices in quality assurance of gynecologic cytopathology.Data Sources.—Data were collected through a written survey consisting of 98 questions submitted to 1245 Clinical Laboratory Improvement Amendments–licensed or Department of Defense laboratories. There were 541 usable responses. Additional input was sought through a Web posting of results and questions on the College of American Pathologists Web site. Four senior authors who authored the survey and 28 cytopathologists and cytotechnologists wer...
Archives of Pathology & Laboratory Medicine, 2021
Context.— Laboratory managers and medical directors are charged with staffing their clinical labo... more Context.— Laboratory managers and medical directors are charged with staffing their clinical laboratories as efficiently as possible. Objective.— To report and analyze the results of 3 College of American Pathologists Q-Probes studies that surveyed the normative rates of laboratory technical staffing ratios. Design.— Participants in the College of American Pathologists Q-Probes program submitted data on the levels of staffing and test volumes performed in their laboratories in 2014, 2016, and 2019. From these data, we calculated departmental productivity ratios, defined as testing volume per full-time equivalent, and degrees of managerial oversight, defined as the ratio of nonmanagement to management full-time equivalents. Participants completed general questionnaires surveying their hospital and laboratory demographics and practices, the data from which we determined demographic and practice characteristics that were significantly associated with technical staffing ratios. Results....
Archives of Pathology & Laboratory Medicine, 2021
Context.— Laboratory managers and medical directors are charged with staffing their clinical labo... more Context.— Laboratory managers and medical directors are charged with staffing their clinical laboratories as efficiently as possible. Objective.— To report and analyze the results of 3 College of American Pathologists Q-Probes studies that surveyed the normative rates of laboratory technical staffing ratios. Design.— Participants in the College of American Pathologists Q-Probes program submitted data on the levels of staffing and test volumes performed in their laboratories in 2014, 2016, and 2019. From these data, we calculated departmental productivity ratios, defined as testing volume per full-time equivalent, and degrees of managerial oversight, defined as the ratio of nonmanagement to management full-time equivalents. Participants completed general questionnaires surveying their hospital and laboratory demographics and practices, the data from which we determined demographic and practice characteristics that were significantly associated with technical staffing ratios. Results....
Context.— Laboratory directors are tasked with staffing laboratories in a manner that provides ad... more Context.— Laboratory directors are tasked with staffing laboratories in a manner that provides adequate services and maintains economic sustainability. Objective.— To determine the national normative rates of phlebotomy staffing and the types of laboratory operational characteristics that may be associated with the magnitude of those staffing levels. Design.— Study participants provided data on inpatient and outpatient phlebotomy sites, including the numbers of patients receiving phlebotomy services, phlebotomy staff, and billable tests. From these data, we calculated performance indicators including the numbers of phlebotomies/phlebotomy full-time equivalent staff, outpatient phlebotomy visits/full-time equivalent staff, and average outpatient phlebotomy wait times. Participants also completed a survey of their laboratory phlebotomy practices. Results.— This study was conducted during the third quarter of 2017. Forty-two institutions participated in this study, providing eligible r...
Context.— Workflow mapping is a tool used to characterize operational processes throughout most i... more Context.— Workflow mapping is a tool used to characterize operational processes throughout most industries and to identify non–value-added activities. Objective.— To develop a set of workflow mapping tools to compare the sequence and timing of activities, including waiting steps, used by clinical laboratories to process specimens during the preanalytic testing phase. Design.— Laboratories enrolled in this College of American Pathologists Q-Probes study created workflow maps detailing the steps they used to process specimens from the time of sample arrival in the laboratory to the time of sample delivery to chemistry analyzers. Enrollees recorded the sequence and types of steps involved in specimen processing and the time needed to complete each step. Results.— Institution average total specimen processing times (SPTs) and the number of steps required to prepare samples varied widely among institutions. Waiting steps, that is, steps requiring specimens to wait before advancing to the...
Context.— Knowledge of laboratory staff turnover rates are important to laboratory medical direct... more Context.— Knowledge of laboratory staff turnover rates are important to laboratory medical directors and hospital administrators who are responsible for ensuring adequate staffing of their clinical laboratories. The current turnover rates for laboratory employees are unknown. Objective.— To determine the 3-year average employee turnover rates for clinical laboratory staff and to survey the types of institutional human resource practices that may be associated with lower turnover rates. Design.— We collected data from participating laboratories spanning a 3-year period of 2015–2017, which included the number of full-time equivalent (FTE) staff members that their laboratories employed in several personnel and departmental categories, and the number of laboratory staff FTEs who vacated each of those categories that institutions intended to refill. We calculated the 3-year average turnover rates for all laboratory employees, for several personnel categories, and for major laboratory dep...
Context.— The College of American Pathologists periodically surveys laboratories to determine cha... more Context.— The College of American Pathologists periodically surveys laboratories to determine changes in cytopathology practices. We report the results of a 2016 survey concerning thyroid fine-needle aspiration (FNA). Objective.— To provide a cross-sectional survey of thyroid cytology practices in 2016. Design.— In 2016, a survey was sent to 2013 laboratories participating in the College of American Pathologists Non-Gynecologic Cytology Education Program (NGC-A) requesting data from 2015–2016 on several topics relating to thyroid FNA. Results.— A total of 878 laboratories (43.6% of 2013) replied to the survey. Radiologists performed the most thyroid FNA procedures in most laboratories (70%; 529 of 756), followed by endocrinologists (18.7%; 141 of 756), and most of these were performed under ultrasound guidance (92.1%; 699 of 759). A total of 32.6% of respondents (251 of 769) provided feedback on unsatisfactory rates for nonpathology providers who performed FNA. Intraprocedural adequ...
Context.— Managing the utilization of laboratory tests is an important quality improvement activi... more Context.— Managing the utilization of laboratory tests is an important quality improvement activity that adds value to health care. Objective.— To examine utilization of 3 laboratory tests and identify factors that impact performance. Design.— Test utilization performance was evaluated by determining the frequency with which appropriate preconditions for testing were met. This included 30 testing episodes each involving (1) free prostate-specific antigen (PSA) when total PSA was within an appropriate interpretable range, (2) total anti–hepatitis A virus antibody when previous anti–hepatitis A virus antibody results were either negative or not done, and (3) factor V Leiden mutation when a previous result was not already available. Participants also provided information regarding some of their utilization policies and procedures for these 3 tests. Results.— The overall frequency with which testing criteria were met was 20.6% (163 of 790), 91.5% (649 of 709), and 95.2% (799 of 839) for...
Archives of pathology & laboratory medicine, Jan 12, 2018
The College of American Pathologists (CAP) developed protocols for reporting pathologic character... more The College of American Pathologists (CAP) developed protocols for reporting pathologic characteristics of breast cancer specimens, including margin status. The Society of Surgical Oncology (SSO) and the American Society for Radiation Oncology (ASTRO) published treatment guidelines regarding margins in patients with invasive cancer; and SSO, ASTRO, and the American Society of Clinical Oncology (ASCO) recently published guidelines for patients with ductal carcinoma in situ. - To assess current practices among pathologists with regard to the processing/reporting of breast specimens, assess compliance with CAP cancer protocols, and assess alignment with SSO/ASTRO and SSO/ASTRO/ASCO guidelines. - A survey concerning breast specimen processing/reporting was distributed to pathologists enrolled in the CAP Performance Improvement Program in Surgical Pathology. - Ninety-four percent (716 of 764 respondents) and 91% (699 of 769 respondents) define positive margins as "tumor on ink"...
Context.-Assessment of customer satisfaction is a vital component of the laboratory quality impro... more Context.-Assessment of customer satisfaction is a vital component of the laboratory quality improvement program. Objective.-To survey the level of physician satisfaction with hospital clinical laboratory services. Design.-Participating institutions provided demographic information and survey results of physician satisfaction, with specific features of clinical laboratory services individually rated on a scale of 5 (excellent) to 1 (poor). Results.-Eighty-one institutions submitted 2425 surveys. The median overall satisfaction score was 4.2 (10th percentile, 3.6; 90th percentile, 4.6). Of the 16 surveyed areas receiving the highest percentage of excellent/good ratings (combined scores of 4 and 5), quality of results was highest along with test menu adequacy, staff courtesy, and overall satisfaction. Of the 4 categories receiving the lowest percentage values of excellent/good ratings, 3 were related to turnaround time for inpatient ''STAT'' (tests performed immediately), outpatient STAT, and esoteric tests. The fourth was a new category presented in this survey: ease of electronic order entry. Here, 11.4% (241 of 2121) of physicians assigned below-average (2) or poor (1) scores. The 5 categories deemed most important to physicians included quality of results, turnaround times for inpatient STAT, routine, and outpatient STAT tests, and clinical report format. Overall satisfaction as measured by physician willingness to recommend their laboratory to another physician remains high at 94.5% (2160 of 2286 respondents). Conclusions.-There is a continued trend of high physician satisfaction and loyalty with clinical laboratory services. Physician dissatisfaction with ease of electronic order entry represents a new challenge. Test turnaround times are persistent areas of dissatisfaction, representing areas for improvement.
Context.-In 2008, the Joint Commission (JC) implemented a standard mandating formal monitoring of... more Context.-In 2008, the Joint Commission (JC) implemented a standard mandating formal monitoring of physician professional performance as part of the process of granting and maintaining practice privileges. Objective.-To create a pathology-specific management tool to aid pathologists in constructing a professional practice-monitoring program, thereby meeting the JC mandate. Design.-A total of 105 College of American Pathologists (CAP)-defined metrics were created. Metrics were based on the job descriptions of pathologists' duties in the laboratory, and metric development was aided by experience from the Q-Probes and Q-Tracks programs. The program was offered in a Web-based format, allowing secure data entry, customization of metrics, and central data collection for future benchmarking. Results.-The program was live for 3 years, with 347 pathologists subscribed from 61 practices (median, 4 per institution; range, 1-35). Subscribers used 93 of the CAP
Context.— Consolidation of clinical microbiology laboratory services has resulted in extended tra... more Context.— Consolidation of clinical microbiology laboratory services has resulted in extended transit time for blood cultures from service points distant from the laboratory. Sepsis is critical; delays in identification of etiologic agents of diseases could adversely impact patient care. Objective.— To examine the effect of total preanalytic time and blood culture volume on the instrument time-to-detection for bacterial pathogens in blood cultures. A secondary objective was to obtain relevant blood culture information by questionnaire. Design.— Participants in this Q-Probes study recorded date, time, and volume information for the first 50 positive blood cultures collected during the 12-week study period. Additional information regarding blood culture collection practices was obtained through questionnaire. Results.— Prolonged overall time-to-detection was secondary to prolonged preanalytic time, particularly prolonged transit time, rather than slower organism growth once bottles we...
Archives of Pathology & Laboratory Medicine, Jul 8, 2021
Context.-Laboratory managers and medical directors are charged with staffing their clinical labor... more Context.-Laboratory managers and medical directors are charged with staffing their clinical laboratories as efficiently as possible. Objective.-To report and analyze the results of 3 College of American Pathologists Q-Probes studies that surveyed the normative rates of laboratory technical staffing ratios. Design.-Participants in the College of American Pathologists Q-Probes program submitted data on the levels of staffing and test volumes performed in their laboratories in 2014, 2016, and 2019. From these data, we calculated departmental productivity ratios, defined as testing volume per full-time equivalent, and degrees of managerial oversight, defined as the ratio of nonmanagement to management full-time equivalents. Participants completed general questionnaires surveying their hospital and laboratory demographics and practices, the data from which we determined demographic and practice characteristics that were significantly associated with technical staffing ratios. Results.-Sixty-seven, 82, and 79 institutions submitted data for the years 2019, 2016, and 2014, respectively. Technical staffing ratios varied widely among the various laboratory departments within each institution and among different institutions participating in this study. With the exception of cytology departments, productivity and managerial oversight ratios did not significantly change between these 3 studies. In the 2019 study, greater testing volumes were associated with higher productivity ratios. Significant associations between managerial oversight ratios and practice characteristics were not consistent across the 3 studies. Conclusions.-Technical staffing ratios varied widely among the various laboratory departments within each institution and among different institutions participating in this study.
Archives of Pathology & Laboratory Medicine, Jun 24, 2020
Context.-Workflow mapping is a tool used to characterize operational processes throughout most in... more Context.-Workflow mapping is a tool used to characterize operational processes throughout most industries and to identify non-value-added activities. Objective.-To develop a set of workflow mapping tools to compare the sequence and timing of activities, including waiting steps, used by clinical laboratories to process specimens during the preanalytic testing phase. Design.-Laboratories enrolled in this College of American Pathologists Q-Probes study created workflow maps detailing the steps they used to process specimens from the time of sample arrival in the laboratory to the time of sample delivery to chemistry analyzers. Enrollees recorded the sequence and types of steps involved in specimen processing and the time needed to complete each step. Results.-Institution average total specimen processing times (SPTs) and the number of steps required to prepare samples varied widely among institutions. Waiting steps, that is, steps requiring specimens to wait before advancing to the next process step, and specimen centrifugation consumed the greatest amount of processing times for both routine and STAT testing. Routine and STAT testing SPTs were shorter at institutions that used rapid centrifuges to prepare samples. Specimen processes requiring more sample waiting steps and computer entry steps had longer aggregate total process times than those with fewer such steps. Conclusions.-Aggregate specimen processing times may be shortened by reducing the number of steps involving sample waiting and computer entry activities. Rapid centrifugation is likely to reduce overall average institutional SPTs.
Archives of Pathology & Laboratory Medicine, Jul 8, 2021
Context.-Laboratory managers and medical directors are charged with staffing their clinical labor... more Context.-Laboratory managers and medical directors are charged with staffing their clinical laboratories as efficiently as possible. Objective.-To report and analyze the results of 3 College of American Pathologists Q-Probes studies that surveyed the normative rates of laboratory technical staffing ratios. Design.-Participants in the College of American Pathologists Q-Probes program submitted data on the levels of staffing and test volumes performed in their laboratories in 2014, 2016, and 2019. From these data, we calculated departmental productivity ratios, defined as testing volume per full-time equivalent, and degrees of managerial oversight, defined as the ratio of nonmanagement to management full-time equivalents. Participants completed general questionnaires surveying their hospital and laboratory demographics and practices, the data from which we determined demographic and practice characteristics that were significantly associated with technical staffing ratios. Results.-Sixty-seven, 82, and 79 institutions submitted data for the years 2019, 2016, and 2014, respectively. Technical staffing ratios varied widely among the various laboratory departments within each institution and among different institutions participating in this study. With the exception of cytology departments, productivity and managerial oversight ratios did not significantly change between these 3 studies. In the 2019 study, greater testing volumes were associated with higher productivity ratios. Significant associations between managerial oversight ratios and practice characteristics were not consistent across the 3 studies. Conclusions.-Technical staffing ratios varied widely among the various laboratory departments within each institution and among different institutions participating in this study.
Archives of Pathology & Laboratory Medicine, Dec 1, 2020
Note: This article was posted on the Archives Web site as an Early Online Release. Early Online R... more Note: This article was posted on the Archives Web site as an Early Online Release. Early Online Release articles have been peer reviewed, copyedited, and reviewed by the authors. Additional changes or corrections may appear in these articles when they appear in a future print issue of the Archives. Early Online Release articles are citable by using the Digital Object Identifier (DOI), a unique number given to every article.
Archives of Pathology & Laboratory Medicine, Jul 17, 2019
Context.-Knowledge of laboratory staff turnover rates are important to laboratory medical directo... more Context.-Knowledge of laboratory staff turnover rates are important to laboratory medical directors and hospital administrators who are responsible for ensuring adequate staffing of their clinical laboratories. The current turnover rates for laboratory employees are unknown. Objective.-To determine the 3-year average employee turnover rates for clinical laboratory staff and to survey the types of institutional human resource practices that may be associated with lower turnover rates. Design.-We collected data from participating laboratories spanning a 3-year period of 2015-2017, which included the number of full-time equivalent (FTE) staff members that their laboratories employed in several personnel and departmental categories, and the number of laboratory staff FTEs who vacated each of those categories that institutions intended to refill. We calculated the 3-year average turnover rates for all laboratory employees, for several personnel categories, and for major laboratory departmental categories, and assessed the potential associations between 3-year average all laboratory staff turnover rates with institutional human resource practices.
Archives of Pathology & Laboratory Medicine, Nov 16, 2021
Context.-Laboratory directors are tasked with staffing laboratories in a manner that provides ade... more Context.-Laboratory directors are tasked with staffing laboratories in a manner that provides adequate services and maintains economic sustainability. Objective.-To determine the national normative rates of phlebotomy staffing and the types of laboratory operational characteristics that may be associated with the magnitude of those staffing levels. Design.-Study participants provided data on inpatient and outpatient phlebotomy sites, including the numbers of patients receiving phlebotomy services, phlebotomy staff, and billable tests. From these data, we calculated performance indicators including the numbers of phlebotomies/phlebotomy full-time equivalent staff, outpatient phlebotomy visits/full-time equivalent staff, and average outpatient phlebotomy wait times. Participants also completed a survey of their laboratory phlebotomy practices. Results.-This study was conducted during the third quarter of 2017. Forty-two institutions participated in this study, providing eligible results for 40 selected inpatient sites and 70 selected outpatient sites. The ratios for all performance indicators spanned between 3.3-and 142fold. The median average outpatient phlebotomy wait time was 8 minutes. None of the performance indicators were associated with the practice variables that we chose to test. Conclusions.-The distribution of phlebotomy staffing performance indicators among the laboratories participating in this study varied widely, even among those groups performing similar volumes of tests.
Context.— Health care organizations face a challenge of assessing preanalytic competency of blood... more Context.— Health care organizations face a challenge of assessing preanalytic competency of blood collectors/phlebotomists (BC/Ps). Objective.— To pilot a novel methodology for BC/P preanalytic competency assessment and identify potential areas for improvement. Design.— Study participants identified preanalytic errors present in 5 blood collection video vignettes. Submitted error descriptions were categorized and then consolidated into a list of standardized required errors for evaluation. Results.— The correct identification of required error rates across all videos viewed by 447 BC/Ps from 46 institutions ranged from 0.7% to 91.9%. The median phlebotomist score across all 5 videos was 55.9% for 440 eligible blood collectors and ranged between 38.2% (10th percentile) and 70.6% (90th percentile). The median institutional score from 42 eligible institutions was 55.9% (range, 43.3%–65.3% for the 10th to 90th percentiles). There were no significant associations between any laboratory p...
Archives of Pathology & Laboratory Medicine, 2013
Context.—Gynecologic cytopathology is a heavily regulated field, with Clinical Laboratory Improve... more Context.—Gynecologic cytopathology is a heavily regulated field, with Clinical Laboratory Improvement Amendments of 1988 mandating the collection of many quality metrics. There is a lack of consensus regarding methods to collect, monitor, and benchmark these data and how these data should be used in a quality assurance program. Furthermore, the introduction of human papilloma virus testing and proficiency testing has provided more data to monitor.Objective.—To determine good laboratory practices in quality assurance of gynecologic cytopathology.Data Sources.—Data were collected through a written survey consisting of 98 questions submitted to 1245 Clinical Laboratory Improvement Amendments–licensed or Department of Defense laboratories. There were 541 usable responses. Additional input was sought through a Web posting of results and questions on the College of American Pathologists Web site. Four senior authors who authored the survey and 28 cytopathologists and cytotechnologists wer...
Archives of Pathology & Laboratory Medicine, 2021
Context.— Laboratory managers and medical directors are charged with staffing their clinical labo... more Context.— Laboratory managers and medical directors are charged with staffing their clinical laboratories as efficiently as possible. Objective.— To report and analyze the results of 3 College of American Pathologists Q-Probes studies that surveyed the normative rates of laboratory technical staffing ratios. Design.— Participants in the College of American Pathologists Q-Probes program submitted data on the levels of staffing and test volumes performed in their laboratories in 2014, 2016, and 2019. From these data, we calculated departmental productivity ratios, defined as testing volume per full-time equivalent, and degrees of managerial oversight, defined as the ratio of nonmanagement to management full-time equivalents. Participants completed general questionnaires surveying their hospital and laboratory demographics and practices, the data from which we determined demographic and practice characteristics that were significantly associated with technical staffing ratios. Results....
Archives of Pathology & Laboratory Medicine, 2021
Context.— Laboratory managers and medical directors are charged with staffing their clinical labo... more Context.— Laboratory managers and medical directors are charged with staffing their clinical laboratories as efficiently as possible. Objective.— To report and analyze the results of 3 College of American Pathologists Q-Probes studies that surveyed the normative rates of laboratory technical staffing ratios. Design.— Participants in the College of American Pathologists Q-Probes program submitted data on the levels of staffing and test volumes performed in their laboratories in 2014, 2016, and 2019. From these data, we calculated departmental productivity ratios, defined as testing volume per full-time equivalent, and degrees of managerial oversight, defined as the ratio of nonmanagement to management full-time equivalents. Participants completed general questionnaires surveying their hospital and laboratory demographics and practices, the data from which we determined demographic and practice characteristics that were significantly associated with technical staffing ratios. Results....
Context.— Laboratory directors are tasked with staffing laboratories in a manner that provides ad... more Context.— Laboratory directors are tasked with staffing laboratories in a manner that provides adequate services and maintains economic sustainability. Objective.— To determine the national normative rates of phlebotomy staffing and the types of laboratory operational characteristics that may be associated with the magnitude of those staffing levels. Design.— Study participants provided data on inpatient and outpatient phlebotomy sites, including the numbers of patients receiving phlebotomy services, phlebotomy staff, and billable tests. From these data, we calculated performance indicators including the numbers of phlebotomies/phlebotomy full-time equivalent staff, outpatient phlebotomy visits/full-time equivalent staff, and average outpatient phlebotomy wait times. Participants also completed a survey of their laboratory phlebotomy practices. Results.— This study was conducted during the third quarter of 2017. Forty-two institutions participated in this study, providing eligible r...
Context.— Workflow mapping is a tool used to characterize operational processes throughout most i... more Context.— Workflow mapping is a tool used to characterize operational processes throughout most industries and to identify non–value-added activities. Objective.— To develop a set of workflow mapping tools to compare the sequence and timing of activities, including waiting steps, used by clinical laboratories to process specimens during the preanalytic testing phase. Design.— Laboratories enrolled in this College of American Pathologists Q-Probes study created workflow maps detailing the steps they used to process specimens from the time of sample arrival in the laboratory to the time of sample delivery to chemistry analyzers. Enrollees recorded the sequence and types of steps involved in specimen processing and the time needed to complete each step. Results.— Institution average total specimen processing times (SPTs) and the number of steps required to prepare samples varied widely among institutions. Waiting steps, that is, steps requiring specimens to wait before advancing to the...
Context.— Knowledge of laboratory staff turnover rates are important to laboratory medical direct... more Context.— Knowledge of laboratory staff turnover rates are important to laboratory medical directors and hospital administrators who are responsible for ensuring adequate staffing of their clinical laboratories. The current turnover rates for laboratory employees are unknown. Objective.— To determine the 3-year average employee turnover rates for clinical laboratory staff and to survey the types of institutional human resource practices that may be associated with lower turnover rates. Design.— We collected data from participating laboratories spanning a 3-year period of 2015–2017, which included the number of full-time equivalent (FTE) staff members that their laboratories employed in several personnel and departmental categories, and the number of laboratory staff FTEs who vacated each of those categories that institutions intended to refill. We calculated the 3-year average turnover rates for all laboratory employees, for several personnel categories, and for major laboratory dep...
Context.— The College of American Pathologists periodically surveys laboratories to determine cha... more Context.— The College of American Pathologists periodically surveys laboratories to determine changes in cytopathology practices. We report the results of a 2016 survey concerning thyroid fine-needle aspiration (FNA). Objective.— To provide a cross-sectional survey of thyroid cytology practices in 2016. Design.— In 2016, a survey was sent to 2013 laboratories participating in the College of American Pathologists Non-Gynecologic Cytology Education Program (NGC-A) requesting data from 2015–2016 on several topics relating to thyroid FNA. Results.— A total of 878 laboratories (43.6% of 2013) replied to the survey. Radiologists performed the most thyroid FNA procedures in most laboratories (70%; 529 of 756), followed by endocrinologists (18.7%; 141 of 756), and most of these were performed under ultrasound guidance (92.1%; 699 of 759). A total of 32.6% of respondents (251 of 769) provided feedback on unsatisfactory rates for nonpathology providers who performed FNA. Intraprocedural adequ...
Context.— Managing the utilization of laboratory tests is an important quality improvement activi... more Context.— Managing the utilization of laboratory tests is an important quality improvement activity that adds value to health care. Objective.— To examine utilization of 3 laboratory tests and identify factors that impact performance. Design.— Test utilization performance was evaluated by determining the frequency with which appropriate preconditions for testing were met. This included 30 testing episodes each involving (1) free prostate-specific antigen (PSA) when total PSA was within an appropriate interpretable range, (2) total anti–hepatitis A virus antibody when previous anti–hepatitis A virus antibody results were either negative or not done, and (3) factor V Leiden mutation when a previous result was not already available. Participants also provided information regarding some of their utilization policies and procedures for these 3 tests. Results.— The overall frequency with which testing criteria were met was 20.6% (163 of 790), 91.5% (649 of 709), and 95.2% (799 of 839) for...
Archives of pathology & laboratory medicine, Jan 12, 2018
The College of American Pathologists (CAP) developed protocols for reporting pathologic character... more The College of American Pathologists (CAP) developed protocols for reporting pathologic characteristics of breast cancer specimens, including margin status. The Society of Surgical Oncology (SSO) and the American Society for Radiation Oncology (ASTRO) published treatment guidelines regarding margins in patients with invasive cancer; and SSO, ASTRO, and the American Society of Clinical Oncology (ASCO) recently published guidelines for patients with ductal carcinoma in situ. - To assess current practices among pathologists with regard to the processing/reporting of breast specimens, assess compliance with CAP cancer protocols, and assess alignment with SSO/ASTRO and SSO/ASTRO/ASCO guidelines. - A survey concerning breast specimen processing/reporting was distributed to pathologists enrolled in the CAP Performance Improvement Program in Surgical Pathology. - Ninety-four percent (716 of 764 respondents) and 91% (699 of 769 respondents) define positive margins as "tumor on ink"...
Context.-Assessment of customer satisfaction is a vital component of the laboratory quality impro... more Context.-Assessment of customer satisfaction is a vital component of the laboratory quality improvement program. Objective.-To survey the level of physician satisfaction with hospital clinical laboratory services. Design.-Participating institutions provided demographic information and survey results of physician satisfaction, with specific features of clinical laboratory services individually rated on a scale of 5 (excellent) to 1 (poor). Results.-Eighty-one institutions submitted 2425 surveys. The median overall satisfaction score was 4.2 (10th percentile, 3.6; 90th percentile, 4.6). Of the 16 surveyed areas receiving the highest percentage of excellent/good ratings (combined scores of 4 and 5), quality of results was highest along with test menu adequacy, staff courtesy, and overall satisfaction. Of the 4 categories receiving the lowest percentage values of excellent/good ratings, 3 were related to turnaround time for inpatient ''STAT'' (tests performed immediately), outpatient STAT, and esoteric tests. The fourth was a new category presented in this survey: ease of electronic order entry. Here, 11.4% (241 of 2121) of physicians assigned below-average (2) or poor (1) scores. The 5 categories deemed most important to physicians included quality of results, turnaround times for inpatient STAT, routine, and outpatient STAT tests, and clinical report format. Overall satisfaction as measured by physician willingness to recommend their laboratory to another physician remains high at 94.5% (2160 of 2286 respondents). Conclusions.-There is a continued trend of high physician satisfaction and loyalty with clinical laboratory services. Physician dissatisfaction with ease of electronic order entry represents a new challenge. Test turnaround times are persistent areas of dissatisfaction, representing areas for improvement.
Context.-In 2008, the Joint Commission (JC) implemented a standard mandating formal monitoring of... more Context.-In 2008, the Joint Commission (JC) implemented a standard mandating formal monitoring of physician professional performance as part of the process of granting and maintaining practice privileges. Objective.-To create a pathology-specific management tool to aid pathologists in constructing a professional practice-monitoring program, thereby meeting the JC mandate. Design.-A total of 105 College of American Pathologists (CAP)-defined metrics were created. Metrics were based on the job descriptions of pathologists' duties in the laboratory, and metric development was aided by experience from the Q-Probes and Q-Tracks programs. The program was offered in a Web-based format, allowing secure data entry, customization of metrics, and central data collection for future benchmarking. Results.-The program was live for 3 years, with 347 pathologists subscribed from 61 practices (median, 4 per institution; range, 1-35). Subscribers used 93 of the CAP
Context.— Consolidation of clinical microbiology laboratory services has resulted in extended tra... more Context.— Consolidation of clinical microbiology laboratory services has resulted in extended transit time for blood cultures from service points distant from the laboratory. Sepsis is critical; delays in identification of etiologic agents of diseases could adversely impact patient care. Objective.— To examine the effect of total preanalytic time and blood culture volume on the instrument time-to-detection for bacterial pathogens in blood cultures. A secondary objective was to obtain relevant blood culture information by questionnaire. Design.— Participants in this Q-Probes study recorded date, time, and volume information for the first 50 positive blood cultures collected during the 12-week study period. Additional information regarding blood culture collection practices was obtained through questionnaire. Results.— Prolonged overall time-to-detection was secondary to prolonged preanalytic time, particularly prolonged transit time, rather than slower organism growth once bottles we...
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Papers by Barbara Blond