Interinstitutional comparison of surgical biopsy diagnosis turnaround time: a College of American Pathologists Q-Probes study of 5384 surgical biopsies in 157 small hospitals.

OBJECTIVES: To study the turnaround time (TAT) for rendering diagnoses on routine biopsy specimens, to examine pathology practice variables that influence TAT, and to assess the level of surgeons' satisfaction with biopsy TAT. DESIGN: Over a 3-month period, voluntary participants in the College of American Pathologists Q-Probes laboratory quality improvement program prospectively collected TAT data on up to 20 biopsy specimens performed on elective surgical cases, completed questionnaires profiling their institution's practice characteristics, and had surgeons complete questionnaires indicating their satisfaction with biopsy report TAT. SETTING AND PARTICIPANTS: One hundred fifty-seven private and public small hospitals located in 43 American states (n = 153), Canada (n = 1), and Australia (n = 3). MAIN OUTCOME MEASURES: The routine surgical biopsy report TATs for 2 testing intervals, each commencing when surgeons acquired the biopsy specimens. One interval concluded when pathologists signed off the biopsy diagnoses, and the other concluded when surgeons received the hard-copy reports. RESULTS: Pathologists signed off 85.9% of 5384 biopsy diagnoses by the second working day, and surgeons received 88.3% of the hard-copy reports by the fourth working day. In 90% of hospitals participating in this study, pathologists signed off half their biopsy diagnoses between the second and third postcollection days, and 90% of surgeons received half their final hard-copy reports by the fourth postcollection day. Institutional practice variables associated with fewer sign-off and/or hard-copy receipt TATs exceeding the institutional 90th percentile performance benchmarks included yearly surgical caseloads greater than 2000 cases per full-time equivalent pathologist, provision of pathology support services on site, and accreditation of the hospital by the Joint Commission on Accreditation of Healthcare Organizations and of the laboratory by the College of American Pathologists. Most (96.4%) surgeons indicated that they were satisfied with hard-copy TATs and that they believed most (98.1%) of the hard-copy TATs had no effect on the lengths of their patients' hospital stays. CONCLUSIONS: Pathologists are capable of signing off most routine biopsy diagnoses within 2 working days and delivering the final hard-copy reports to surgeons within 4 working days (both intervals measured from the time that surgeons collect biopsy specimens). Most surgeons report they are satisfied with this level of performance.

Timeliness of urinalysis: a College of American Pathologists Q-probes study of 346 small hospitals.

OBJECTIVE: To explore preanalytic handling of urinalysis specimens. DESIGN: The study was a College of American Pathologists Q-Probes study consisting of two parts. The first part was a questionnaire about participants' urinalysis practices. The second part required collection of information from four specific urinalysis specimens per shift on 30 consecutive days or from 200 urine specimens, whichever occurred first. SETTING: Three hundred forty-six small hospitals enrolled in the Small Hospital Q-Probes program. MAIN OUTCOME MEASURES: Compliance with guidelines requiring nonrefrigeration and specimen measurement within 2 hours of collection, and identification of practices associated with better performance. RESULTS: Almost 50,000 urinalysis specimens were analyzed. About 68% of the specimens were measured without prior refrigeration, 2.3% were refrigerated before, 17.9% were refrigerated after, and 4.5% were refrigerated before and after arrival in the laboratory. Aggregate analysis indicated that 11.2% of never-refrigerated specimens exceeded the recommended 2-hour time standard before analysis. For inpatients and outpatients, respectively, 64% and 77% of laboratories were able to meet the 2-hour goal 90% of the time. Improved performance was associated statistically with ordering urinalysis stat, an enforced policy of specimen rejection for delayed transport of inpatient specimens, and the listing of a collection time for outpatient specimens. CONCLUSIONS: A large number of urinalysis specimens exceeded current quality guidelines for handling. Laboratories must monitor and improve preanalytic handling of urinalysis specimens.

Effects of formaldehyde, acetaldehyde, benzoyl peroxide, and hydrogen peroxide on cultured normal human bronchial epithelial cells.

The effects of several aldehydes and peroxides on growth and differentiation of normal human bronchial epithelial cells were studied. Cells were exposed to formaldehyde, acetaldehyde, benzoyl peroxide (BPO), or hydrogen peroxide (HPO). The effect of each agent on the following parameters was measured: (a) clonal growth rate; (b) squamous differentiation; (c) DNA damage; (d) ornithine decarboxylase activity; (e) nucleic acid synthesis; (f) aryl hydrocarbon hydroxylase activity; and (g) arachidonic acid and choline release. None of the agents were mitogenic, and their effects were assessed at concentrations which reduced growth rate (population doublings per day) to 50% of control. The 50% of control concentrations for the 6-h exposure were found to be 0.065 mM BPO, 0.21 mM formaldehyde, 1.2 mM HPO, and 30 mM acetaldehyde. BPO-exposed cells were smaller than controls (median cell planar area, 620 sq microns versus 1150 sq microns), and acetaldehyde-exposed cells were larger than controls (median cell planar area, 3200 sq microns). All agents increased the formation of cross-linked envelopes and depressed RNA synthesis more than DNA synthesis. HPO caused DNA single-strand breaks, while formaldehyde and BPO caused detectable amounts of both single-strand breaks and DNA-protein cross-links. Other effects included increased arachidonic acid and choline release due to HPO. The similarities and differences of the effects of these aldehydes and peroxides to those caused by tumor promoters are discussed.

The efficacy of the autopsy in medical quality assurance.

Autopsy is seen as the foundation of a pathology information service that possesses intrinsic value in the enhancement of medical care of the seriously ill. However, if it is to survive as a cost-effective consultative practice in the hospital setting, consideration must be given to the scientific principles of both information management and behavioral change strategies at the organizational level. The rationale for goals and the methodology are discussed.

Acute effects of 12-O-tetradecanoylphorbol-13-acetate, teleocidin B, or 2,3,7,8-tetrachlorodibenzo-p-dioxin on cultured normal human bronchial epithelial cells.

Effects of teleocidin B, 12-O-tetradecanoylphorbol-13-acetate (TPA), phorbol, 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) and 2,7-dichlorodibenzo-p-dioxin (DCDD) on normal human bronchial epithelial cell cultures were assessed by quantitation of cellular morphology, clonal growth (population doublings per day), cross-linked envelope (CLE) formation and the enzymatic activities of aryl hydrocarbon hydroxylase (AHH), ornithine decarboxylase (ODC) and plasminogen activator (PA). Toxicity was assessed by clonal growth assays. Teleocidin B and TPA had similar effects on growth, morphology and enzyme activities. When the cells were incubated with TPA or teleocidin B at concentrations of 1-100 nM for 6 h, RNA synthesis was unaffected, but DNA synthesis decreased and squamous differentiation, marked by an increase in cell surface area and cross-linked envelope formation, was increased. TPA and teleocidin B also increased ODC activity in LHC-0 medium (a maintenance medium without epidermal growth factor) but caused a decrease of ODC activity in LHC-4 (a growth medium containing epidermal growth factor). Finally, TPA and teleocidin B each caused an increase of PA and a decrease of AHH activities in both media. Phorbol, a non-promoting analogue of TPA, had no effect on growth, morphology or biochemical assays. TCDD (100 nM) caused a 15% decrease in cell growth when cells were incubated in LHC-4, and this was accompanied by an increase in cell surface area, PA activity, and CLE formation. TCDD caused an increase in AHH and ODC activities when the cells were incubated in either LHC-0 or LHC-4 medium. DCDD did not alter cell growth, and its morphological and biochemical effects were similar to those of TCDD although less marked. In conclusion, results reported here are consistent with the hypothesis that an important property of some tumor promoters is their ability to induce terminal differentiation in normal, non-initiated epithelial cells.

Ion movements in cell injury. Effects of the cationic detergent cetyl pyridinium chloride on the ultrastructure and function of the toad bladder.

The effects of a cationic detergent, cetyl pyridinium chloride (CPC), on toad bladder epithelium were studied by means of electrophysiologic and sodium-flux measurements, chemical analysis, time-lapse phase-contrast cinemicrography and electron microscopy. At 10(-5) M, CPC caused a rapid loss of net sodium transport as reflected by the short-circuit current (SCC) but except for striking prominence of the glycocalyx, this dose caused no ultrastructural changes for at least 18 hours. Only a moderate decrease in resistance and increase in passive sodium flux were noted. At 10(-4) M, CPC caused a transient 1 to 2-minute increase in the bladder's rate of oxygen consumption followed by a decrease, and a rapid decline in SCC, followed a few minute later by a decrease in resistance accompanied by a greatly increased passive leak to sodium. A sequence of ultrastructural changes typical of other forms of lethal cell injury progressed to extensive cellular disruption by 1 hour after treatment with 10(-4) M CPC. In addition, unusual surface membrane changes were observed, consisting of extensive formation of vesicles and myelin figures at the cell surface. A significant fraction of the bladder's cholesterol content appeared in the incubation medium after 10(-4) M CPC treatment. With 10(-3) M CPC, a similar pattern of cellular degeneration proceeded much more rapidly, and in addition, the cellular remains reorganized into complex lamellar arrays resembling phospholipid crystalloids. The results are interpreted as indicating that in addition to inhibiting net sodium transport, CPC lethally injures cells by interfering with the function of the surface membrane as a permeability barrier, and in addition, leads to a drastic structural reorganization of membrane constituents.