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WHAT IS THE
GOLD STANDARD FOR PAP TAT?
As to this file/page you have been directed to:
it's @ Dr. Shaw's personal website
Since Pap smear screening is not a medical
emergency (or even medically urgent), interest in getting a result quickly makes much less
sense than an intense quality focus on optimizing the detection of cervical
abnormalities & cancer. However, many patients are anxious and hyper-demanding and
pressure their doctor for an answer. So, turn-around-time (TAT) had become a competitive
business factor among labs during the days of independent physician practice. Average or current TAT may be easy to compare between
labs. But quality is not. One key note: Sudden growth spurts in Pap smear volume or
difficulty obtaining/retaining qualified cytotechnologists can profoundly affect TAT
(especially if the lab is absolutely committed to highest quality...which is our position).
TAT
factors:
- Quality of specimen
sample and demographic information (TAT increases if either is poor): The lab can't "make up"
for a poor sample. And insurance companies require very exact information or they won't pay for
your test. It is sometimes many days before we can get the office obtaining the Pap sample to
to get the info back to us [and they may have been delayed as they tried to find the patient
and get her to respond with the missing info.). All such information...including that office
giving us their assignment of various billing codes which we must copy onto our reports...goes
into our correct submission legally required billing codes so that a "clean claim" is billed
out by our billing company so that the patient's insurance might pay on your bill from the
lab/pathologist.
- accessioning: in
order that we are always able to find your previous medical information AND so that this new
Pap result can be correlated accurately with prior info AND that we can find other pertinent
medical info that might be in LMC's electronic medical records on each specimen, our hospital
has the Pap smear function staffed one shift per day, 5 days per week. A case is only
accessioned into the electronic system AFTER the above federally-required correct information
has been received. This involves Meditech pre-registration, Co-Path order entry, and Team IA
requisition scanning on each and every Pap case.
- Transport: Effectiveness and
efficiency of the courier or specimen submission process system (specimen delays arriving to
the lab increase TAT).
- Clerical & Prep: Adeptness/efficiency
of lab clerical and cytopreparatory personnel (slow or poorly trained/supervised or poorly
equipped personnel increase TAT). Where a lab provides liquid-based Pap sample services, there
is an entire preparatory process that did not have to be done in the "old days" of the
"conventional Pap". All Paps are screened in our lab by professionally by skilled
cytotechnologists (not true in many labs) searching for cell and other abnormalities (many labs
only screen for cell abnormalities). And, if the test is also backed up by
artificial-intelligence computerized screening (we do this on all cases that the instrument
will "accept"...about 98%), this is an entire additional process.
- Attracting employees: Inability of a lab
(for whatever reason) to pay wages enough to get proper employees may lead to less-good
personnel.
- Supply of employees: A poor supply of
personnel in a geographic area could lead to less-good, less efficient doctor office or lab
personnel.
- Work-hours restrictions: Inability (lack of
funds, unwilling to spend the funds, employees unable to work overtime) to work personnel
enough hours to reduce TAT. The Cytology Dept. at Lexington Medical Center cannot staff
24/7/365 and works one shift per day, the 5 weekdays per week. Increase TAT.
- Adequate team #1: Inability to hire,
retain, or work enough hours: cytotechnologists. Increases TAT.
- Adequate team #2: Inability to hire,
retain, or work enough hours: pathologists. Increases TAT.
- Back-up: Inability to "farm
out" excess workload (due to government restrictions, lack of "takers", inadequate capability
of "takers", etc.) increases TAT.
- Government Case Volume Restrictions: Inability to work
cytotechnologist screeners as many hours and cases per week as some would like (governmental
restrictions) increases TAT.
If you are reading this file as a:
- patient: hope that
you get the sharpest-eyed, best-quality job possible done on your Pap sample...and let your
doctor or us know of any special needs or expectations regarding TAT (see below).
- lab manager: hope
that you can afford a top quality Pap process and be spared unreasonable demands.
- clinical doctor:
provide the best Pap sample possible and let your lab know of any special needs or expectations
regarding TAT (see below).
- curious citizen: if
you are female and are, or have been, sexually active, be sure that you make your annual
appointment & get regular Pap smears!
IN
CLOSING:
Being set toward doing the best job we can do for the trusting patient (yet being realistic), our
gold standard for TAT ( since this hospital opened in 1971) at Lexington Medical Center is to have
a target TAT of 5 business days and consider ourselves in "problem territory" if TAT gets over 10
business days. In 2015, our TAT on normals is 2-3 days and abnormals about 5 days. Because of personnel vacation and sickness, a little fluctuation is unavoidable.
Remember, it is always possible for pressured people and businesses to bend these factors so as to
meet special needs/demands of a particular patient or patient situation (we welcome a "heads up"
phone call or attached note to the requisition on any such case [803-791-2485]). May I take this moment to encourage reasonableness on the
part of all parties.
***give me your comments about this
page***
check out the Highest
TRUTH
(posted 17 Feb. 2001; latest update 20 May
2015)
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