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[377] Dissemination of Toyota Methods To Improve Quality and Patient Safety in Pap Testing

CM Vrbin, C Andrew-Jaja, DM Grzybicki, JL Condel, G Carter, SS Raab. University of Pittsburgh, Pittsburgh, PA

Background: We previously showed that Toyota Production System (TPS) methods may be used to redesign a single gynecologists practice and cytology lab service to reduce Pap test error and improve Pap test quality. Our goal was to determine if TPS process redesign may be implemented widely across a group of clinicians and multiple lab personnel to improve cervical cancer screening patient safety.
Design: We performed a one-year non-concurrent interventional cohort study that included 5384 case and 5442 control women who had a Pap test procured by one of five clinicians. We implemented a continuous flow, one-by-one process in the cervical cancer screening practices of 4 gynecologists and 1 nurse practitioner. For each Pap test, the clinicians used a TPS checklist that allowed the clinician to focus on every step of Pap test procurement. We assigned a unique cytotechnologist to screen the Pap tests from every clinician, and the cytotechnologists provided immediate feedback regarding specimen adequacy and abnormal results to each clinician. To evaluate adequacy, we measured pre (control) and post (case) implementation proportion of Pap tests with unsatisfactory and absent endocervical transformation zone component (ETZC) interpretations. We also measured the proportion of women with missed and detected cervical intraepithelial neoplasia (CIN) and with a missed squamous intraepithelial lesion (SIL).
Results: After the intervention, the mean proportion of Pap tests lacking a transformation zone component decreased from 17.3% to 15.1% (P = .001) and the proportion of unsatisfactory Pap tests decreased from 1.3% to 0.9% (P = .008). The case group of women showed a 113% increase in newly detected CIN following a previous benign Pap test procured the previous year (P = .004), indicating a missed SIL in the previous year. The case group of women also showed a 16% increase in detected CIN.
Conclusions: Disseminating TPS methods across a group of clinicians and cytotechnologists resulted in improved sampling and fewer false negative diagnoses. TPS redesign resulted in improved communication between the cytology lab and the clinicians and an increased focus on work. Initiatives that target the entire testing pathway help to improve patient safety.
Category: Cytopathology

Tuesday, March 27, 2007

Poster # 75, Tuesday Morning