Timeliness of result is considered an important aspect of the services provided by laboratory. To provide the clients accurate, timely and relevant information is one of the fundamental objectives of quality assurance programs in anatomic pathology. Turnaround time (TAT) is defined as the time when test is ordered until the result is reported. In 2000 Rosai also explained that the purpose of anatomic pathology turnaround time is to monitor the timely reporting of surgical and autopsy pathology specimens and to correct any deficiencies encountered.
In the diagnosis of cancer and other disease condition, time is very essential. Timely reporting of results will decrease the length of hospital stay for the in-patients. It will also provide relevant information for the referring physicians that will help them provide an appropriate treatment to the patients. Furthermore, timeliness of result can reduce the period of uncertainty for the patients’ waiting for their result.
In our institution, delayed turn-around time is one of the major problem. Hence, this study is conducted. The study aims to identify the factors that affect the surgical pathology turnaround time in our institution. According to the previous studies, TAT is prolonged due to the following factors: larger institutional size, greater specimen volume, delayed slide delivery, reduced support staff, and the integration of pathology trainees. In 2011 Patel et al indicate that diagnosis of malignancy, consultation with other pathologists, having had frozen section, number of H and E slides and use of immunohistochemical stains were significantly associated with increased turnaround time.
Identifying factors that prolonged the turnaround time is the initial step in implementing process improvement in the work flow system of our institution. This study will help us identify the areas of weakness in the laboratory that can help us improve our service.
Review of Related Literature
Turnaround time is divided into three phases: Preanalytic, analytic and postanalytic phase. The pre-analytical phase include specimen collection, transport and processing. The analytical phase include the testing and the post analytical phase include transmission, interpretation and follow up. The three processes are called the testing process. In surgical pathology, analytic phase can be divided into technical part and analysis. The technical part include gross examination, tissue processing, microtomy, staining, and mounting while analysis part include reading of biopsy specimens. In 2014, a study by Shamim et al showed that most of the delays are in the analytical phase. This can be due to machine breakdown. In 2003, Bilwani et al pointed some of the reasons of delayed turnaround time and these include machine breakdown, delay in maintenance analyzer and due to computer shut down. Among the factors that have significant contribution to delayed turnaround time are diagnosis of malignancy, consultation with other pathologists, number of H and E slides and the use of immunohistochemical stains. Cases having an increased number of H and E slides reflects submission of additional tissue specimens and requires technical time to complete the specimens (Patel, 2000). According to Bowers in 2012, specimens that require special handling has a particular significant impact in turnaround time. There is an increased in turnaround time in specimens that require special handling as compared to specimens of routine cases. Some specimen types that require overnight fixation can prolong the processing time. In this study, the author also quoted that governmental institutions were found to have significantly longer turnaround time than non-governmental institutions. In 2013, Volmar et al., stated that the longer turnaround time in governmental institution is a reflection of different staffing patterns and/or turnaround time expectations in certain institutions.
Specimen type also varies in their turnaround time. Radical cancer resections have the longest median turnaround time. This is followed by non-radical cancer resections and non-cancer resections have a least number of days in turnaround time (Bowers, 2012). Specimen types that are associated with longer turnaround time include gastrointestinal, breast, lung and genitourinary. This can be explained by an overnight fixation of these specimens. (Volmar et al, 2013). In 2013, Forlenza et al, the turnaround time for pediatric oncology pathology varies according to diagnosis. Tumors of the CNS has the most increased in TAT, this is followed by sarcoma, ovarian tumors, kidney tumors, thyroid tumors, schwannoma/neurofibroma, nasopharyngeal carcinoma, kidney tumors, testicular tumors, lymphoma, neuroblastoma and hepatoblastoma.
Interdepartmental consultation on complex cases can also prolong the turnaround time. Ribe et al., explained that complex cases can increase the turnaround time because of additional time for complete processing and special studies such as immunohistochemical staining. Large specimens require more time of fixation and calcified tissues require decalcification which is time consuming. Other factors that affects the turnaround time are the need of additional recuts and review and reprocessing of previous surgical pathology or cytopathology. (Ribe, 1998). Significantly longer turnaround time was also associated with pulling old slides for review and contacting the physicians for additional information. (Jones, 2001)
Manpower is an essential factor in any institutions that require quality service. Staffing practices can also be a factor in the timeliness in surgical pathology result. A study by Volmar in 2013, most of the institutions (51.9%) reported staffing of 12 hours or less. A small percentage (13%) of institutions having 24 hour staffing.
For institutions with training program, in 1996, Zarbo et al pointed the factors that contributed to increased turnaround time and these include the following: Routine responsibility for gross dissection assigned to residents only and residents’ involvement in signing out of result. In 1999, Jones et al cited that turnaround time was significantly longer when residents or fellows were involved in screening and releasing of results. The need to contact the attending physician for additional information can also give a longer turnaround time.
According to the Association of Directors of Anatomic and Surgical Pathology (ADASP) turnaround times are variable depending on case complexity and other factors such as the presence of a residency training program. The standards may change over time with the advent of new technologies and other factors. They also stated that acceptable turnaround time “should be determined on the basis of current literature, keeping in mind that acceptable turnaround times are also defined by the accrediting bodies. (ADASP, 2012)
In Davao City, the average turnaround time of tertiary hospitals is 7 days. In our institution the turnaround time for biopsy specimen is 10 days.
Our institution is a government training hospital and one the referral centers in Mindanao. Annually, there is an increasing volume of specimens that we received. In 2013 the biopsy census was approximately 7000 and 8000 in the year 2014. This study aims to identify the factors that affect the delayed turnaround time in our institution.
What are the factors that affect the surgical pathology turnaround time in Southern Philippines Medical Center?
Significance of the Study
Turnaround time is an essential component of quality measures in surgical pathology. To implement new system for improving the turnaround time in surgical pathology, one must be able to identify first the factors that affect the turnaround time. Identifying these factors will be of help in solving our problem. Hence, this study will enable us to identify areas of weakness that will lead us to implement changes which will improve the service of the laboratory in our institution. Such changes include formulation and planning of protocols that can help improved the turnaround time in surgical pathology. The data that will be collected at the end of this study will serve as a reference data. This data can be used for future studies which will compare the turnaround time after the implemention of changes. Furthermore, this study serves as an evaluation of the efficiency of our laboratory in terms of biopsy specimens.
The general objective of this study is to determine the factors that affect the analysis phase of turnaround time of biopsy specimens in Southern Philippines Medical Center.
- To determine the mean turnaround time of biopsy specimens in Southern Philippines Medical Center.
- To determine if the following factors are significantly associated with delayed turnaround time:
- Non-Radical or Radical Specimens
- Number of specimens and H and E slides
- Cancer versus Non-cancer Cases
- Consutation with other Pathologists
- Tissue decalcification
- Frozen section biopsy
- To determine which of the above factors can cause more delays compared to the rest.
- To determine which organ system specimen type is significantly associated with delayed turnaround time.
- To determine if average TAT is significantly different between:
- cancer and non-cancer cases
b) radical and non-radical specimens
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