67 Identification of a key bottleneck in the current CAP on-site peer inspections and its downstream effects

The College of American Pathologists (CAP) oversees on-site peer inspections of more than 8,000 accredited laboratories on a biennial basis - a manual process involving multiple steps for the inspection teams as well as the inspected laboratories. CAP still relies heavily on printed inspection packets while other accreditation agencies have transitioned to digital platforms, and the continued use of reams of papers in the inspection process poses several challenges that have not yet been addressed. This study aims to quantify the extent of paper utilization in CAP inspections, capture the downstream logistical challenges and potential inefficiencies in the overall inspection process, and explore the possibility of a digital solution. The data generated here are based on 4 different high-volume CAP-accredited laboratories inspected by teams from our institution over the last 5 years. First, we tabulated the total number of single-sided sheets printed for each inspection, which was further broken down by sub-laboratories or sections where applicable. We then estimated the weight of these materials based on standard paper metrics (100 sheets = ∼1 pound), and extrapolated these calculations to 800 laboratories to reflect recent estimates that approximately 10% of CAP-accredited laboratories operate at similarly high volumes. Finally, we interviewed inspection team leaders and members to capture their experience with using paper documents. Across the 4 laboratories, total paper usage for inspection packets amounted to 20,666 sheets. The breakdown by laboratory revealed a significant outlier, with one facility utilizing 12,656 sheets while the remaining 3 laboratories averaged 2,670 sheets each. Based on the latter value, biennial inspections of the projected 800 high-volume CAP accredited laboratories alone account for 1,068,000 sheets of paper annually, or 5.34 US tons (∼4.8 metric tonnes). Inspectors also reported logistical difficulties with physical packets, including outdated versions circulating despite manual updates, time spent searching for specific requirement IDs, additional inspection time required for missing sections discovered at summation, and the hassle of locating a UPS shipping center to return inspection reports. Given the limited sample size, our analysis focused solely on high-volume laboratories and did not account for differences in test complexity or variety. This study clearly highlights the significant volume of paper used in CAP peer inspections and the resulting inefficiencies of the current inspection process. Our exploration of the CAP website showed that key elements for a paperless system already exist within CAP’s e-LAB Solutions Suite, where laboratories upload their proficiency testing results in real time and maintain organization profiles for use by peer inspection teams. The transition to a cloud-based system would not only reduce the physical, financial, and environmental burden on peer inspectors but also align CAP with other accreditation bodies for a more modern and efficient inspection process.