Inappropriate Frozen Sections: An Analysis To Determine Utilization Validity, and the Need To Educate Physicians as Part of a QA Program
C Tornos, P Kane, M Singh. Stony Brook University Medeical Center, Stony Brook, NY
Background: Part of our current QA process is to assess appropriateness of frozen section (FS) requests, and determine any patterns of use that need to be corrected. Valid indications for a frozen section include: establish a diagnosis that needs immediate additional surgery or other therapy, determine adequacy of surgical margins and establish whether the specimen obtained contains enough viable lesional tissue for diagnosis. Inappropriate requests for frozen section include: to satisfy clinical curiosity, desire solely to communicate results to the family, or locate anatomical landmarks that should be recognizable by any surgeon. We report the results of reviewing FSs performed in the last 12 months at our hospital.
Design: A computer search of all FSs performed during the last 12 months (7/08 to 6/09) was conducted on a monthly bases for our QA review. We examined all pathology reports, and pertinent clinical history provided. The FSs were deemed appropriate according to the criteria mentioned above. FSs that seemed inappropriate were further investigated and were discussed with the requesting physician if needed. If there was no justifiable reason for the FS the request was categorized as inappropriate.
Results: A total of 1177 FSs were performed, of which 1165 (98.9%) were done for appropriate reasons including: 838 (71%) to establish a diagnosis for immediate treatment, 225 (19%) to assess surgical margins, and 102 (8.6%) to determine adequacy of tissue. The remaining 12 (1%) were requested for inappropriate reasons. In 5 of these when the FS diagnosis was called the surgery had already finished and the surgeon could not be located. In 7 cases the surgeons confirmed that nothing else would have been done based on the result of the FS. Five of these were done after hours or on weekends. Three surgeons accounted for 11/12 cases. They were personally contacted by the Director of the service and appropriateness of the FS request was discussed with them. Monitoring to assess whether the meetings were effective in correcting utilization of FSs is underway.
Conclusions: FS requests need to be monitored in each institution to identify inappropriate utilization and provide opportunities for education of surgeons with the aim of improving patient care, avoiding misuse of fresh tissue, and encouraging optimal expenditure of resources.
Category: Quality Assurance
Tuesday, March 23, 2010 11:30 AM
Platform Session: Section H 2, Tuesday Morning