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The '87 update to CAP workload recording.

The '87 update to CAP workload recording

Like its predecessors, the 1987 edition of the College of American Pathologists' Manual for Laboratory Workload Recording Method provides expanded test code lists with unit values, improvements in test classification, and a more logical approach for collecting workload data. It numbers 250 pages, 50 more than the 1986 edition.

The last three editions of the manual brought substantial changes in assigned unit values for many procedures, and these changes produced apparent reductions in workload and productivity. The unit values that were changed had been based on time studies performed as long as 10 years before. Studies indicated a need for recalibration.

With such comprehensive adjustments in unit values already accomplished, the major changes in the 1987 manual are in procedure codes and terminology. The manual has also been reformatted and contains a new standard section that provides unit values for general laboratory support. Here's what's new in 1987:

* Procedure codes. Virtually all the immunology and more than 400 chemistry CAP procedure codes have been reassigned in the 1987 manual. In earlier manuals, a single analyte--particularly among the therapeutic drugs and toxic substances--had several five-digit procedure codes. Each code identified the same analyte as measured by a different method. Many analytes had no unit values at all, and the same analyte could have different procedure codes in chemistry and immunology.

In the 1987 manual, there's only one five-digit procedure code per analyte, with a three-digit suffix code added on to indicate the analytical method or instrument and the unit value. For example, phenytoin has four suffix codes, identifying the unit values for EMIT, GLC, HPLC, and ultraviolet procedures (Table I). This expanded coding system made it possible to assign unit values to hundreds of new or existing procedures. It was also necessary, however, to reassign many procedures and suffix codes.

In immunology, a single five-digit CAP procedure code number is assigned to each organism, cellular substance, complement component, or immunoglobulin for which testing can be performed (Table II). As in chemistry, the three-digit suffix code identifies the analytic method (agglutination, fluorescence, automated instrument, etc.) and the unit value. The three-diti immunology suffix code further specifies whether the procedure is a test for an antigen or an antibody. Suffix codes .500 to .699 are used for tests involving antigens and .700 to .899 for tests involving antibodies.

* Terminology. Earlier editions of the manual contained three types of unit values--permanent and temporary (t), based on time studies, and extrapolated (e). This year, only two types are applied--either the unit value per procedure or the extrapolated unit value.

The unit value per procedure, also called the assigned unit value, covers procedures or instruments on which a statistically valuid number of time studies have been performed and reviewed. It is defined as the number of laboratory workload units (minutes) of technical, clerical, and aide time consumed in performing all the activities required to complete the procedure once.

The workload recording committee may assign an extrapolated unit value to a procedure or instrument before standard time studies are performed. This value may be dervied from components of earlier time studies or from time studies performed on similar procedures or instruments. It is designated by a lower case "e," which immediately precedes the unit value in the procedure and suffix code lists.

The 1987 manual uses the terms workloaded and non-workloaded in place of specified and non-specified. Workloaded activities are test-related and generate workload units. Non-workloaded activities include such tasks as orientation, purchasing, scheduling, and budget preparation, which are essential to overall lab operation but do not generate workload units. The new terminology more accurately describes the two categories of activity.

* Format. The workload recording committee has also redesigned the manual to make it more user-friendly. In the past, three lists of procedures--numerically by code, alphabetically by procedure name, and alphabetically within each discipline--ran at the end of the manual. This forced users to flip a number of pages back and forth between text and lists. Now the alphabetical "within section" procedure lists are incorporated into the text. For example, the list of chemistry procedures immediately follows the manual's discussion of chemistry.

The committee has also added a new standard section, general laboratory support, which consolidates activites that do not relate to a single procedure or test but rather support or assist in the performance of many tasks. For example, CAP code number 86194 (checking timer on centrifuge), with a unit value of 5.0/centrifuge, does not lead directly to a reportable result, but it is a necessary step in many procedures that do generate results.

The general laboratory support section is not used for interlaboratory comparison. It covers centrifuge calibration, checking the centrifuge with a tachometer, checking the centrifuge timer, disposal of contaminated material, instrument thermometer reading and daily temperature recording, report charting, report delivery (manual), travel time outside the lab to provide technical assistance within the institution, and washing the bench top.

These procedures were scattered throughout previous manuals, depending on where the original time studies were performed (mostly in the blood bank and microbiology). The new section merely groups the procedures in a single chapter for easy reference. They will still be assigned to as many functional and scientific sections as are appropriate.

* New publications. The CAP has suspended publication of Counterpoints, a newsletter for users of the workload recording method. All CAP newsletters have been assimilated into CAP Today, a new tabloid introduced this year and distributed free of charge. If you are interested in receiving CAP Today, write Ms. Karie Sax, Publications and Marketing. College of American Pathologists, 5202 Old Orchard Rd., Suite 100, Skokie, Ill. 60077, or phone (312) 966-5700.

* Transition tables. The college has prepared special transition tables that help ease the conversion to the new workload recording procedure codes. The tables automatically accompany the 1987 manual and need not be ordered separately. The manual costs $25 and can be purchased by sending a check or purchase order to the CAP's Publications Order Department, same address as above.
COPYRIGHT 1987 Nelson Publishing
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 1987 Gale, Cengage Learning. All rights reserved.

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Title Annotation:College of American Pathologists' Manual for Laboratory Workload Recording Method
Author:Barrett, Barbara J.; Conn, Rex B.
Publication:Medical Laboratory Observer
Article Type:Bibliography
Date:Mar 1, 1987
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