Workload Recording by Microcomputer

469

BRIEF SCIENTIFIC REPORTS

Vol. 74 • No. 4

precipitation radioimmunoassay for plasma CEA determination has been well documented by Reynoso and associates." Our purpose has been to show that this direct method is comparable to the Hansen method in sensitivity and specificity, that the values obtained are, in most cases, interchangeable, and that this is true not only among patients who have colorectal cancer, but also among those who have other diseases. The availability of a commercial kit allows the ready use of this method. Acknowledgments. Advice and help was provided by Dr. J. E. Coates, and technical assistance by Mrs. A. Robinson and Miss E. Goon. HofTman-LaRoche, Nutley, New Jersey, provided the CEA kits. The Department of Hospitals and Medical Care, the National Cancer Institute of Canada, and the Edmonton Police Benevolent Society provided financial support.

References I. Ashman LK, Ludbrook J, Marshall VR: Comparison of whole plasma and perchloric acid-extracted plasma assays for carcinoembryonic antigen. Clin Chim Acta 74:77-84, 1977

2. Egan ML. Lautenschleger JT. Coligan JE. et al: Radioimmune assay of carcinoembryonic antigen. Immunochemistry 9: 289-299, 1972 3. Fleisher M, Besenfelder E. Oetlgen HF. et al: Comparison of carcinoembryonic antigen (CEA) methodologies. Ann Clin Lab Sci 4:357-362. 1974 4. Hansen HJ, Snyder JJ, Miller E. et al: Carcinoembryonic antigen (CEA) assay. A laboratory adjunct in the diagnosis and management of cancer. Hum Pathol 5:139-147. 1974 5. Kim YD, Tomita JT, Schenck JR: A simplified solid-phase radioimmunoassay for carcinoembryonic antigen. J Immunol Methods 19:309-316. 1978 6. LoGerfo P, Krupey J, Hansen HJ: Demonstration of an antigen common to several varieties of neoplasia. N Engl J Med 285:138-141. 1971 7. MacSween JM, Warner NL. Bankhurst AD, et al: Carcinoembryonic antigen in whole serum. Br J Cancer 26:356-360. 1972 8. McPherson TA, Koch M. Coates JE: Evaluation of a direct radioimmunoassay for carcinoembryonic antigen. Clin Biochem 11:169-171. 1978 9. Reynoso G. Keane M, Konopka S: Proficiency testing for the radioimmunoassay of carcinoembryonic antigen. Am J Clin Pathol 68:170-174, 1977

Workload Recording by

Microcomputer

ALAN M. NORBUT, M.D., PHILIP R. FOULIS, M.D., AND HARVEY MENDELOW, M.D.

Norbut, Alan M, Foulis, Philip R., and Mendelow, Harvey: Workload recording by microcomputer. Am J Clin Pathol 74: 469-471, 1980. Workload recording as designed by the College of American Pathologists has proven to be an invaluable aid in the assessment of overall laboratory operation. The administrative information derived from the compilation of these workload statistics is utilized to provide effective and efficient laboratory management. A microcomputer-based system for the pathology department that permits the accumulation of daily raw workload data is described. A monthly cumulative summary report is subsequently produced, complete with computer-derived College of American Pathologists workload units. (Key words: Microcomputer; Workload recording.) T H E P R O G R E S S I V E A U T O M A T I O N of t h e pathology laboratory, most notably in the clinical chemistry d e p a r t m e n t , has paralleled the annual 10% to 15% increase in the n u m b e r of laboratory p r o c e d u r e s performed. This situation, together with the requirements of various regulatory agencies, has emphasized Received September 14, 1979; accepted for publication September 26, 1979. Address reprint requests to Dr. Mendelow: Department of Pathology, The Montefiore Hospital, Fifth Avenue at Darragh, Pittsburgh, Pennsylvania 15213. 0002-9173/80/1000/0469 $00.65 © A

Department of Pathology, University of Pittsburgh Health Center, and Department of Pathology, Montefiore Hospital, Pittsburgh, Pennsylvania

the need for a standardized method of assessing laboratory productivity. The workload recording method of the College of American Pathologists (CAP),1 has provided a uniform method of characterizing current levels of laboratory activity. Workload recording has proven to be a useful adjunct to more traditional methods of laboratory management.2~" It provides an accurate overview of current laboratory activity, including the assessment of both instrumentation and technician productivity. The administrative information obtained is essential for the projection of future laboratory requirements for equipment, supplies, or personnel, as well as in the evaluation of current test procedures. Additionally, workload recording can assist in cost-analysis and other forms of budgetary management for the pathology laboratory. The specifics of workload recording as defined by the CAP are as follows. Each test or procedure is assigned a "raw count" value of one. A "unit value" ican Society of Clinical Pathologists

470

NORBUT, FOULIS, AND MENDELOW

A.J.C.P. . October 1980

Table I. Monthly Cumulative Summary Report for Histopathology, Montefiore Hospital, August 1979 Total Specimens Raw 580 38 10 25 12 28 18 91

Routine surgical Frozen section Consult Neuropathology Autopsy Decalcification Renal biopsy Research

Totals 802 Total raw counts 4,535 Total CAP workload units 61,168

Number of Blocks

CAP

Raw

CAP

11,600 988 200 500 4,800 560 360 1,820

1,740 47 10 175 287 12 20 91

20,828

2,382

Additional Slides

Special Stains

Raw

CAP

Raw

17,400 470 100 1,750 3,731 120 200 910

247 8 0 80 87 3 59 130

1,482 48 0 480 522 18 354 780

518 10 3 35 63 8 79 21

7,770 150 45 1,050 945 120 1,580 315

24,681

614

3,684

737

11,975

CAP

Pathologist

is then assigned according to the CAP guidelines, where one unit is equivalent to one minute of technical, clerical, or laboratory aide time, beginning with the initial handling of the specimen in the laboratory and continuing until a final result is obtained. The total workload units for a specific procedure are then derived from the multiplication of the raw count and the unit value for the procedure, with the result expressed as workload in minutes. As it is most commonly employed, the manual recording of workload raw counts and corresponding unit values, with the ultimate calculation of CAP workload units, occupies a significant amount of supervisory time and effort. Although a computer-assisted workload recording program is available through the CAP, 1 raw data must still be tabulated manually before the monthly submission for computer compilation. We have found that a relatively inexpensive microcomputer can assist in the recording, summation, calculation, and storage of daily workload data, with the production of a monthly cumulative workload summary report, complete with computer-derived total CAP workload units. Table 2. Daily Summary Log for Department of Chemistry, Montefiore Hospital, August 22, 1979 (DuPont ACA®) Totals Lipase CSF protein Calcium Creatinine Glucose Magnesium Amylase Lactic acid Phenobarb Dilantin

0 12 31

Controls

Repeats

Dilutions

Urines

0 3 3 1 6 1 1 0 2 3

0 1 2 0 5 0 1 0 0 0

0 0 0 0 2 0 0 0 0 0

0 0 0 3 5 0 1 0 0 0

Fluids

0 0 0 0 1 0 0 0 0 0 Pathologist

Accordingly, we have developed a package of microcomputer-based programs, written in BASIC, to assist in the compilation and storage of workload units accumulated in the pathology department of Montefiore Hospital, a 500-bed adult acute-care medical-surgical facility associated with the University of Pittsburgh Health Center. The pathology laboratory processes approximately 2.2 million specimens annually, the equivalent of 6.1 million CAP workload units. A Northstar Horizon II microcomputer* was employed for program development and implementation. Additional system hardware consists of a CRT (cathode ray tube) for visual display and a small impact printer for hardcopy printout. The microcomputer utilizes two disk drives, each with 180,000 bytes of storage with five-and-one-quarter-inch diskettes. The programs were developed totally inhouse by two of us, (A.M.N, and P.R.F.) without professional programmer assistance. Although written in Northstar Basic, the programs are readily adaptable to any microcomputer system. Typically, these systems cost between $1,500 and $5,000. Additionally, these programs can be easily updated to reflect changes in laboratory practice, with the inclusion of new test procedures, or the elimination of discontinued routines. The knowledge and expertise of various departmental supervisors was used to define unique departmental requirements, allowing for customization of the format for input of raw data counts. For example, the department of histopathology is presented with a single CRT format based upon the nature of the specimen to be processed, (