Use of a Laboratory Information System (LIS) Driven Tool for Cytopathologist Pre-Signout Quality Assurance.
Sonal N Kamat, Anil V Parwani, Walid Khalbuss, Sara E Monaco, Susan M Kelly, Luke T Wiehagen, Anthony L Piccoli, Karen M Lassige, Liron Pantanowitz. University of Pittsburgh Medical Center, Shadyside Hospital, PA
Background: A quality assurance (QA) program is designed to detect, control and prevent errors. A novel pre-signout QA tool (PQAT) at our institution allows the LIS to automatically and randomly select an adjustable percentage of non-gynecological cytology cases for prospective review by a second cytopathologist before release of the final report. The aim of this study was to review our experience with using this novel PQAT and to determine its effectiveness in the cytopathology laboratory.
Design: Software modifications were made to the existing LIS application (CoPathPlus, Cerner) to allow for QA peer review of random cases prior to signout. Following implementation of PQAT in February 2009 at two medical centers (UPMC-Shadyside & UPMC-Presbyterian), a cytopathologist had around 8% of their cases randomly selected at the time of electronic signout for peer review by a second cytopathologist. An assigned QA cytopathologist reviewed the selected cases and entered their interpretation (agreement or major/minor disagreement) with comments directly into the LIS. The original pathologist was provided with the opportunity to rectify any detected errors before the case was signed out. The reviewing pathologist was entered into the LIS as a consultant. Data from cases selected for PQAT over an 18 month period (Feb 2009-Aug 2010) were collected and analyzed using descriptive statistics.
Results: The total number of non-gynecological cases subjected to pre-sign out QA review during this time period was 1,339 (7.45%) out of a total of 17,967 cases signed out. For the vast majority of cases (1,304 cases; 97.4%) cytopathologists agreed with the entered diagnosis. There was a disagreement in 2.6% of cases, including 34 (2.5%) with minor disagreements (such as 14 thyroid FNAs involving FLUS cases and 3 bronchoalveolar lavages where fungus was missed) and only one major disagreement identified (overcalled CSF specimen which was confirmed to be negative for leukemia using flow cytometry). Average turn around time of cases selected for the PQAT was 1.56 days, compared to an average of 2 days for all non-gynecological cases signed out.
Conclusions: The PQAT is a novel mechanism in non-gynecological cytopathology that provides an automated prospective QA method for preventing potential diagnostic errors from occurring. This process allows for a second peer review and potential corrective action prior to the reporting of a diagnosis without delaying turn around time, in order to decrease the potential for errors and thereby improve patient safety.
Category: Quality Assurance
Monday, February 28, 2011 9:30 AM
Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 239, Monday Morning