Development and Use of Laboratory Information System (LIS) Driven Tool for Pre-Signout Quality Assurance of Random Surgical Pathology Reports
AV Parwani, R Dhir, S Yousem, S Kelly, A Piccoli, L Wiehagen, K Lassige. UPMC - Shadyside Hospital, Pittsburgh, PA
Background: In many institutes, all or a subset of cases are reviewed routinely by a second pathologist as a method of quality assurance (QA). Studies have shown that error rates range from 0.26% to 1.2% for global in-house prospective review and 4.0% for retrospective review. The aim of the current study was to develop a Pre-Signout Quality Assurance Tool (PQAT) which allows the LIS to randomly select 5% of cases for QA and send that case to the QA pathologist for review.
Design: Several vendor-assisted software modifications were done to our existing LIS application, CopathPlus. These modifications and the design of the new PQAT takes into account our existing workflows. The blinded signout pathologist will have a case randomly selected 5% of the time prior to signout. As soon as the case is selected and with the knowledge of the primary pathologist, the case is sent to a QA work list where an assigned QA pathologist reviews the case and either agrees or disagrees with the original diagnosis and enters their comments into the LIS. At this point the case is returned to the original pathologist and it is signed out.
Results: The first version of PQAT has been built and tested for review of GenitoUrinary Pathology cases. When the pathologist presses the Signout button, surgical pathology cases are considered for QA selection. Cases selected for QA are routed to the QA Work list. The QA pathologist reviews all cases on this work list and enters a new QA review. The case is then sent to the original pathologist's signout work list. Agreement level is displayed on the work list so that the original pathologist must review the QA findings and resolve discrepancies with his/her diagnosis. The QA comments and review is strored in the LIS and is not displayed on the surgical pathology report. The tool and existing workflow has been tested on multiple cases in our test LIS system. The percentage of cases for QA can be modified according to requirements and this tool can be expanded to all surgical pathology benches.
Conclusions: Since we are a subspecialty-based sign out practice, we routinely do not have a second prospective review of cases. The PQAT and the designed workflow allows for corrective action and re-review of randomly selected cases, prior to signout. This tool will also result in real time QA rather than a retrospective QA process. The PQAT will also allow for focused QA based on the difficult or controversial areas of the subspecialty.
Wednesday, March 11, 2009 9:30 AM
Poster Session V # 217, Wednesday Morning