Improving Quality and Completeness of Cancer Pathology Reporting: Results of a Large Scale 8 Year Canadian Project
John Srigley, Dimitrios Divaris, Tom McGowan, James Brierley, Marta Yurcan, Jonathan Irish, Robin McLeod, Jillian Ross, Robin Rossi, Tim Yardley, Rachel Schill, MaryJane King, Jennifer Hart, Dana Wilson-Li, Carol Sawka. Cancer Care Ontario, Toronto, ON, Canada; McMaster University, Hamilton, ON, Canada; Grand River Hospital, Kitchener, ON, Canada; Credit Valley Hospital, Mississauga, ON, Canada; University Health Network, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada; Mt. Sinai Hospital, Toronto, ON, Canada; University Health Network & Mt Sinai Hospital, Toronto, ON, Canada
Background: Standardizing electronic pathology reporting in discrete synoptic format across a large population (13.5 million) involving over 60,000 new cancer cases per year, 116 acute care hospitals and over 400 pathologists is no small feat. This 8 year initiative improved the quality of cancer pathology reports by standardizing the content to align with the College of American Pathologists (CAP) cancer protocols and electronic checklists (eCCs). A change management strategy enabled the uptake of standardized electronic synoptic pathology reporting.
Design: The mandate to standardize electronic pathology reporting was delivered through a central agency to all 52 primary reporting facilities (a total of 116 acute care facilities). The adoption of eTools in all participating hospital laboratory information systems (LIS) provided pathologists with preformatted drop down lists based on the CAP eCCs. Phase 1 implemented 5 high volume checklists (breast, CRC, lung, prostate and endometrium). Phase 2 expanded the mandate to 63 checklists using the eCC standard. Change management strategies targeted practice change enablers (clinical leadership, KTE, audits) and system change enablers (funding, standards adoption, LIS vendor engagement, process improvement).
Results: In 2004, 95% of acute care hospitals submitted pathology reports in non-standardized narrative or synoptic-like formats, with completeness rates audited at 68% on the CAP Cancer Protocol standard (breast, prostate, lung, CRC). As of March 2012, 97% of hospitals use discrete data field electronic pathology reporting. Over 90% of cancer resections for the mandated 63 eCCs are submitted monthly in synoptic format with a completeness rate of >90%. The data forms the basis for several clinical-pathology performance metrics.
Conclusions: The success of implementing electronic synoptic pathology reporting across a large population is attributed to the key enablers for change, especially clinical engagement and regular auditing applied at participating sites and facilitated through a central agency focusing on quality improvement.
Category: Quality Assurance
Monday, March 4, 2013 1:45 PM
Proffered Papers: Section G, Monday Afternoon