Validating a Checklist for the Gross Examination of Benign Uteri.
Margaret S Ryan, Maxwell L Smith, Greg R Kotnis, Trent A Wilkerson, Stephen S Raab. University of Colorado, Aurora
Background: Checklists are a means to standardize and improve work quality. Although published manuals describe a standard process of gross tissue examination, the development, validation, and implementation of grossing checklists has not been reported. We describe the method of checklist development and validation for benign uteri, based on an assessment of current practice.
Design: We developed a novel benign uterus checklist that included the important components of the gross dictation, including specimen condition, weight and measurements, description of the serosa, exocervix, os, endocervix, endometrium and myometrium, and the listing of sections submitted. The content of the checklist was based on expert opinion, clinical experience and previously published gross examination protocols. Five participants independently reviewed 25 actual surgical pathology reports of benign uteri and assessed 62 components of the gross dictation report using the checklist. For each item, the participants selected whether the gross activity had been performed well, performed poorly, or not performed. We validated the checklist by assessing the level of observer agreement. Items that had >75% agreement were considered validated in the assessment process.
Results: Out of the 62 checklist items, 50 of the items were validated by the 5 participants. There was not concordance among the graders regarding the description of anatomic structures present and the specimen condition. For these two components of the checklist, there was only 60% and 64% concordance, respectively. Specific items, such as the color and texture of the endometrium, were not validated on 8 and 7 specimens, respectively (32% and 28%); for these items, observers ranged in classification from performed well to performed poorly to not performed. The description of most pathologic lesions (e.g., leiomyoma) were not validated (only 36% of myometrial lesions were validated). The sufficiency of sections submitted was very poorly agreed upon, with only 12%, 48%, and 44% agreement for the adequacy of submitted sections from the serosa, endometrium and myometrium, respectively.
Conclusions: Using standardized checklists, observers were not able to validate approximately 20% of benign uterine grossing metrics. These findings indicate that a challenge in gross tissue examination is the high level of variability in the assessment of whether grossing practices were performed well or poorly.
Category: Quality Assurance
Monday, February 28, 2011 1:00 PM
Poster Session II # 226, Monday Afternoon