From the President’s Desk—QI: rigor, precision, scope, and depth

Create PDF

R. Bruce Williams, MD

August 2019—I am always interested in learning what is new in CAP laboratory improvement. My first inspection was some 40 years ago and our work in that realm has grown faster and gone further than I could have imagined back then.

The CAP accredited its first laboratory in 1964 and published the first checklist several years later. I’m told that when Dennis B. Dorsey, MD (a then-future CAP president), submitted the first draft at 10 pages, his fellow LAP commissioners asked that he try to make it shorter. Today our 21 checklists contain approximately 3,000 requirements. The science grows ever more complex, but we do our best to be concise.

R. Bruce Williams, MD

CAP laboratory accreditation promotes excellence in laboratory practice. Our member volunteers steer the program as inspectors and team leaders, training new colleagues in making every inspection an educational experience for all involved. They also serve on committees whose work fosters excellence in practice and enables discernment, both during the inspection and when the data are crunched and the reports are written.

The CAP proficiency testing program is overseen by 600-plus physicians and doctoral scientists who serve on the 32 discipline-specific scientific committees that report to the Council on Scientific Affairs. The CSA committees produce PT products and do the highly complex work associated with accreditation by acting as resources for technical inquiries related to inspections, validate results, and envision next steps for the checklists. Our fine staff keeps the boat afloat, seeing that we keep pace with information technology and maintaining relationships with regulatory agencies and physician groups in related specialties.

While each CAP laboratory quality improvement tool bolsters the effectiveness and efficiency of CAP laboratory accreditation, it’s likely that none is better known than our proficiency testing program, CAP Surveys. More than 22,000 laboratories worldwide choose CAP proficiency testing. In 2018, we offered 650 Surveys, including 28 new programs (seven of which targeted next-generation sequencing). We have 18 new Surveys for 2019 and one of those (glucose, insulin, and C-peptide) is matrix effect free (or accuracy based). That gives us a menu of 10 matrix-effect–free programs.

Proficiency testing is integral to CAP laboratory quality assurance. While the Clinical Laboratory Improvement Amendments of 1988 require that laboratories report PT results for just 83 analytes plus microbiology subspecialties, laboratories that choose CAP accreditation prefer a higher level of scrutiny. CAP experts have identified more than 300 additional analytes whose clinical utility and medical relevance are critical to patient care and safety, and laboratories that choose the CAP submit results for those analytes as well.