Initial Experience with a Novel Pre-Signout Quality Assurance Tool (PQAT) for Review of Random Surgical Pathology Diagnoses in a Subspecialty-Based University Practice
SR Owens, LT Wiehagen, SM Kelly, AL Piccoli, SA Yousem, R Dhir, AV Parwani. University of Pittsburgh Medical Center, Pittsburgh, PA
Background: Quality assurance and quality improvement are important parts of surgical pathology (SP) practice, particularly given current attention to patient safety and healthcare cost containment. Our subspecialty-based practice recently instituted a novel laboratory information system (LIS)-based PQAT that randomly selects SP reports for mandatory prospective review by a second pathologist in the same center of excellence. We now have data from the first 8 months of its use.
Design: The PQAT selects an adjustable percentage of cases for review, allowing real-time documentation of diagnostic agreement or one of three levels of disagreement: minor, moderate or major. The review must be completed prior to case verification. Originating pathologists are blinded to the selection activity by the LIS. The review level was 5% from January-May 2009, and 8% from June-August 2009. The number and level of diagnostic disagreements found using the PQAT were analyzed and compared to those in a similar timeframe prior to its implementation. SP case turnaround time (TAT) was also analyzed.
Results: 1523/23968 (6.4%) SP cases were reviewed between January and August 2009. 1489 (97.8%) resulted in diagnostic agreement. There were 33 (2.17%) minor and 1 (0.07%) moderate, but no major disagreements. Over the corresponding 8 months in 2008 (using a random post-signout review level of 5% with a 2-month lag between diagnosis and review), 1140/23698 (4.9%) of cases were reviewed, with 1109 (97.3%) in agreement. There were 25 (2.19%) minor, 5 (0.44%) moderate and 1 (0.09%) major disagreements. Average TAT for cases reviewed using the PQAT was 2.47 days while average TAT for non-reviewed cases in the same time period was 2.13 days (p=0.84).
Conclusions: Similar discrepancy levels were identified using pre- and post-signout review methods, and use of the PQAT caused no significant change in TAT. The PQAT has the advantages of saving time and effort in slide retrieval for retrospective review, identifying errors in real time, and stimulating discussion of diagnostic approach as cases are being encountered. Additionally, while no major diagnostic disagreements were identified using the PQAT during the time period studied, the prospective nature of the novel tool should allow for prevention of some major diagnostic errors in addition to the identification of process errors and difficult case subsets.
Category: Quality Assurance
Tuesday, March 23, 2010 11:45 AM
Platform Session: Section H 2, Tuesday Morning