A-218 Streamlining CAP on-site peer inspections: A digital solution to address key constraints of utilizing paper inspection packets

Abstract Background The College of American Pathologists (CAP) peer inspection program relies heavily on printed inspection packets, which poses logistical, financial, and environmental challenges especially prior to summation. Although thousands of inspections for CAP accreditation occur annually, no published reports evaluate their efficiency or recognize opportunities to improve the peer inspection format. This study aims to quantify paper utilization in CAP inspections, identify inefficiencies in the current workflow, and propose a digital platform to minimize paper waste, enhance collaboration, and improve the overall CAP peer inspection process. Methods We analyzed data from 4 high-volume CAP-accredited laboratories inspected by teams from our institution over the past 5 years. For each inspection, we tabulated the total number of single-sided sheets printed, further stratifying usage by sub-laboratories or sections where applicable. Using standard paper metrics (100 sheets = ∼1 lb), we estimated the weight of these materials and extrapolated the calculations to 800 laboratories, reflecting recent estimates that approximately 10% of the 8,000 CAP-accredited laboratories operate at similarly high volumes. Additionally, inspection team leaders and members provided qualitative insights on document management, transport logistics, and the potential benefits of a digital platform. Results Across the 4 laboratories, paper usage for inspection packets totaled 11,221 sheets, or an average of 2,805 sheets each. Based on the latter, biennial inspections of the estimated 800 high-volume CAP-accredited laboratories account for 1,122,000 sheets annually, or 5.61 US tons (∼5.1 metric tonnes). Notably, packet sizes correlated more closely with laboratory complexity, including test variety and sub-laboratory sections, than with overall test volume. The logistical burden of paper-based inspections was evident, with inspection teams highlighting issues including transportation costs, outdated document versions circulating after manual updates, prolonged search times for specific requirement IDs, delays due to missing sections discovered at summation, and challenges in returning inspection packets. Given the limited sample size, our analysis focused on high-volume laboratories and did not account for variations in test complexity. Furthermore, our analysis did not capture copies printed by the laboratories undergoing inspection or other limitations that they faced. Conclusion With over 8,000 CAP-accredited laboratories, this study underscores the substantial burden associated with paper-based CAP inspections and the need for a paperless solution. A transition to a cloud-based inspection platform would mitigate paper waste and associated costs, streamline access to real-time updates, facilitate rapid searching of checklists, and enable more efficient time management by inspection teams. Encouragingly, CAP’s e-LAB Solutions Suite already allows laboratories to upload proficiency testing results in real time and maintain organization profiles for use by peer inspectors, while CAP inspection specialists currently conduct inspections using CAP-issued iPads instead of paper documents. Expanding these existing digital tools to peer inspections could provide additional benefits, such as integrated inspector training modules, real-time support from CAP staff, and mobile accessibility for inspection teams. Laboratories undergoing inspection could also gain access to digital reports, enhancing transparency and post-inspection workflows. This initiative would align CAP with other accrediting bodies that have transitioned to digital inspections while improving the overall peer inspection experience.