Laboratory Turnaround Time of Surgical Biopsies at a Histopathology Service in Nigeria.

INTRODUCTION: Laboratory turnaround time is defined as the time between the receipt of a sample in the laboratory and when the report is ready for collection/dispatch. It is a critical component of the quality assurance of a laboratory and has been identified as a key performance indicator of laboratory performance. This study is aimed at evaluating the turnround time in the histopathology unit of our center and comparing the findings with that of similar studies.
METHODOLOGY: This was a prospective descriptive study of the first 500 consecutive samples of surgical biopsies submitted for analyses at the Histopathology Department of the Jos University Teaching Hospital. The samples were tracked from the reception desk, where they are submitted to the dispatch point where the results are collected by clients. The grossing time (T1), processing time (T2), reporting time (T3), and the transcription time (T4) were recorded for each sample. The data obtained were analyzed using SPSS software and presented as simple frequencies and percentages.
RESULTS: The mean laboratory turnaround time was 7.5 + 9.7 days with a range of 3-18 days. As much as 20.8% of reports were ready for dispatch by day 3 and 100% by day 18. Overall, the grossing time (T1), processing time (T2), reporting time (T3), and transcription (T4) time consumed 17.5%, 35.5%, 27.7%, and 19.3% of the total time spent, respectively.
CONCLUSION: We recommend the development of practicable targets for the histopathology laboratories as regards timeliness. This should be regularly evaluated to ensure compliance and improvement of service quality in this regard. Copyright:

INTRODUCTION

In the hospital setting, laboratory TAT (LTAT) is the time between the receipt of a sample in the laboratory and when the report is ready for collection/dispatch.123456 LTAT is a critical indicator of laboratory performance.7891011121314 Delay in issuance of reports contributes to prolonged patients' treatment-waiting time, decreases satisfaction, and increases hospital cost.15

Pathology practice in developing countries has reportedly been characterized by system delays associated with obtaining, processing, and reporting analyzed samples. This study is aimed at evaluating the TAT in the histopathology unit of our center and comparing the findings with that of similar studies.

METHODOLOGY

This was a prospective descriptive study of the first 500 consecutive surgical samples submitted for analyses at the Histopathology Department of the Jos University Teaching Hospital. The samples were tracked from the reception where they were submitted to the point where the results were ready for collection by clients.

The time interval between these extremes (the laboratory turnaround time) was segmented into four composite parts (proportion of samples undergoing procedures completed over time). The grossing time (T1) is the time (in days) between sample submissions and the moment grossing is completed. This is followed by the processing time (T2) (the period during which the tissue is processed), the time between the completion of grossing of a tissue and submission of histological slides for reporting. Therefore, T1 and T2 constitute the preanalytical phase. The reporting time (T3) represents the period of reporting and is defined as the interval between the submission of samples for reporting and the time it is sent out for typing. It is the analytical phase. Finally, the transcription (T4) time (the postanalytical phase) is the period during which the reports undergo typing, proofreading, and printing. Reports are immediately ready for collection/dispatch. All times were consecutive calendar days including the weekend. The data obtained were analyzed using Statistical Package for the Social Sciences (SPSS) software (IBM. SPSS statistics for Windows. Version 21.0. Armonk, NY: IBM; 2017) and presented in Table 1 as simple frequencies and percentages.

Table 1

Distribution of time intervals as proportion of samples undergoing procedures completed over time (days) toward turnaround time in surgical pathology

Day(s)	Proportion of samples completed in composite parts of LTAT
	T1=Grossing time (%)	T2=Processing time (%)	T3=Reporting time (%)	T4=Transcription time (%)	Total=LTAT=T1 + T2 + T3 + T4 (%)
1	59.6	17.0	43.8	87.6	-
2	74.2	32.0	63.4	92.4	-
3	92.4	49.4	71.2	94.4	20.80
4	97.6	63.6	76.2	100.	33.00
5	100.0	76.0	80.8	-	43.00
6	-	93.8	86.0	-	54.80
7	-	94.6	87.4	-	64.20
8	-	100.0	100.0	-	73.20
9	-	-	-	-	81.80
10	-	-	-	-	88.40
11	-	-	-	-	92.40
12	-	-	-	-	95.20
13	-	-	-	-	97.40
14	-	-	-	-	98.40
15	-	-	-	-	99.40
16	-	-	-	-	99.60
17	-	-	-	-	88.80
18	-	-	-	-	100.00

LTAT – Laboratory turnaround time

Only the four authors of this work who are primary staff of the laboratory with a total of 43 staff were aware that this study was ongoing.

There were no ethical issues as the research does not involve the direct use of patients' information or diagnosis reached on samples, but strictly time intervals.

RESULTS

The mean laboratory turnaround time was 7.5 ± 9.7 days with a range of 3–18 days. As much as 20.8% of reports were ready for dispatch on day 3 and 100% on day 18 [Table 1]. The mean grossing time, processing time, reporting time, and transcription time were 1.6 ± 1.6 days, 3.5 ± 3.8 days, 1.9 ± 5.0 days, and 1.1 ± 2.5 days, respectively, with corresponding ranges of 1–5 days, 1–8 days, 1–8 days, and 1–4 days.

The proportion of samples grossed, processed, reported, and transcribed on day 1 were 59.6%, 17.0%, 43.8%, and 87.6%, respectively.

Overall, the grossing time (T1), processing time (T2), reporting time (T3), and transcription (T4) time consumed 17.5%, 35.5%, 27.7%, and 19.3% of the total time spent, respectively.

DISCUSSION

Turnaround time in the laboratory is an integral component of quality assurance.1214 In this study, it ranges between 3 and 18 days. Similar values of 2–16 days and 2–27 days were reported in Kano, Nigeria, and Barcelona, Spain, respectively.1617 Furthermore, a report from Eldoret, Kenya, of 3–59 days was however higher.14 Furthermore, the mean of 7.5 ± 9.7 days in our study is similar to 6.2 days in Kano,16 6.24 ± 3.16 days in Spain,17 but lower than the 16.2 ± 10.20 days in Kenya.14 Furthermore, a study from Rwanda presented a median of 32 days for LTAT.11 It was reported that the gap between developing and developed countries in TAT is attributable to factors bordering on intralaboratory constraints, interprofessional rivalry, poorly structured internal/external quality assurance programs, inadequate infrastructures, politics, and the economy.18 However, this study suggests a glimmer of hope in the drive toward efficiency of the developing countries in this regard.

LTAT could be graded based on the proportion of requests completed with the passage of time. The College of American Pathologists recommended that LTAT for routine surgical biopsies should be no longer than 2 days, with more complex cases lasting longer.1920 The Royal College of Pathologists recommended in 2013 that the percentage of diagnostic biopsies reported, confirmed, and authorized within 7 days of biopsy should be 80%. However, at a later date in 2014, the threshold was pegged at 90%. Furthermore, the percentage of all histopathology and diagnostic cytology final reports available within 10 calendar days of procedure be earlier pegged at 80% increased to 90% by April, 2014.21 The Royal College of Pathologists of Ireland gave a target of 80% of cases be completed by day 5.2 Our online search showed that national or local guidelines on LTAT in histopathology were not readily available. This calls for a deliberate action by the authorities in developing countries to build capacity and ensure sustainable timelines and accountability in order to bridge the gap in this regard.

We recorded an LTAT of 20.80%, 54.80%, 73.20%, and 92.40%, respectively on days 3, 6, 8, and 11. Volmar et al. in an American Q-Probes study involving 56 institutions with reports on 2763 large or complex histology cases found a median turnaround time of 2.72 days.22 In Ireland, a hospital met national standards in 2017 with 80% of small and endoscopic biopsies being reported by day 5, while 80% of cancer and noncancer resections were reported by day 7.23 This difference between our center and these Western nations is attributable to the factors highlighted above.

In this study, we found the preanalytic, analytic, and postanalytic phases accounting for 53.0%, 27.7%, and 19.3%, respectively, of the total time consumed. A Nigerian study by Uchendu18 reported a similar finding: 57.9%, 28.1%, and 13.9%, respectively. The analytic phase in histopathology is the exclusive duty of the anatomical pathologist12 and was found in this study to have a mean of 1.9 ± 5.0 days and range of 1–8 days. This was better than the reported mean of 3.6 ± 2 days in Kenya by Macbaria et al.14 and the 2.5 ± 3.2 days in Nigeria by Atanda et al.24 The rate of reporting on day 1 was 43.8% in this study, a value similar to the 40.7% reported in Nigeria,24 but lower than the 73.4% in Australia.25

CONCLUSION

This study showed that although a gap exists in the LTAT between developed and developing climes, some improvements have so far been noticed. We therefore recommend the development of practicable targets for the histopathology laboratories as regards timeliness. This should be regularly evaluated to ensure compliance and improvement of service quality in this regard.

Financial support and sponsorship

Nil.

Conflicts of interest

Four of the seven authors in this study are part of the 21 doctors that are routinely involved in surgical pathology services in the laboratory based on their schedule. They also are part of the 43 staff of the laboratory as a whole involved in the entire turnaround time process.