Adequacy of surgical pathology reporting of cancer: a College of American Pathologists Q-Probes study of 86 institutions.

CONTEXT: Inclusion of all scientifically validated elements in surgical pathology cancer reports is needed for optimal patient care. OBJECTIVE: To evaluate the frequency with which surgical pathology cancer reports contain all the scientifically validated elements required by the American College of Surgery (ACS) Commission on Cancer (CoC), the extent to which checklists are used, and the effects that the use of checklists have on the completeness of cancer reports. DESIGN: Participants in the College of American Pathologists voluntary Q-Probes program reviewed 25 consecutive surgical pathology reports to include cancer reports from breast, colon, rectum, and prostate cancer specimens. For each report, the type and total number of missing required elements, deemed essential by the ACS CoC, was recorded. RESULTS: A total of 2125 cancer reports were reviewed in 86 institutions; 68.8% of all surgical pathology cancer reports included all the required elements. Institutions in which checklists were routinely used reported all required elements at a higher rate than those that did not use checklists (88% versus 34%), and institutions that had a system in place to track errors also reported all required elements at a higher rate when compared to those that did not have such a system in place (88% versus 68%). The missing mandated elements, common to cancer reports of all tumor types, were extent of invasion and status of the resection margin. CONCLUSIONS: This study demonstrates that about 30% of cancer reports do not have all the scientifically validated elements required by the ACS CoC. Pathology departments in which checklists are not routinely used have a substantially lower rate of reports that include all the required elements.

Physician satisfaction with surgical pathology reports: a 2-year College of American Pathologists Q-Tracks Study.

CONTEXT: There are multiple elements that can be measured to assess the quality of a surgical pathology laboratory. Overall customer satisfaction is an excellent "global" measure, because it highlights the unique insight of laboratory performance from the users' perspective. OBJECTIVE: To measure customer satisfaction with surgical pathology reports. DESIGN: This study was based on a subscription Q-Tracks study. Voluntary participants were asked to distribute and collect a minimum of 25 surveys per quarter from their clients. Four parameters were graded, which included overall satisfaction, report turnaround time (TAT), completeness, and style on a scale of 1 (poor) to 5 (excellent). Each laboratory submitted quarterly data to the College of American Pathologists, where the data were tabulated and analyzed. Each laboratory could compare their performance in all 4 measures against the entire cohort or a selected subgroup of laboratories. Overall customer satisfaction with surgical pathology reports and 3 subcategories of report TAT, completeness, and style were the main outcome measures. RESULTS: This study ran during 2004 and 2005, with 41 and 33 participant laboratories, respectively. The median score for overall satisfaction, TAT, completeness, and style were 4.57, 4.31, 4.62, and 4.64 in 2004, and 4.64, 4.56, 4.65, and 4.68 in 2005, respectively. Most laboratories reported results for 4 quarters or fewer. There was no statistically significant change in overall satisfaction over time. CONCLUSIONS: Overall satisfaction scores for surgical pathology reports as well as satisfaction with report TAT, completeness, and style were high. Report TAT received the lowest scores of all parameters.

Hospital nursing satisfaction with clinical laboratory services: a College of American Pathologists Q-Probes study of 162 institutions.

CONTEXT: Monitoring customer satisfaction is an important and useful quality improvement tool and is required of most clinical laboratories in the United States. OBJECTIVE: To survey the level of nursing satisfaction with hospital clinical laboratory services. DESIGN: Participating laboratories provided information regarding laboratory demographics and practices. These laboratories then surveyed hospital nursing personnel regarding their level of satisfaction with defined aspects of laboratory service. SETTING: College of American Pathologists Q-Probes laboratory quality improvement study in 162 hospital laboratories. MAIN OUTCOME MEASURES: Nursing overall satisfaction score (ranging from 1, not satisfied, to 5, very satisfied) and satisfaction scores for 13 specific aspects of clinical laboratory services. RESULTS: One hundred sixty-two institutions submitted data from a total of 7033 nursing surveys. The overall satisfaction score for all institutions ranged from 2.5 to 4.6. The median overall score for all participants was 3.9 (10th percentile, 3.2; 90th percentile, 4.2). Nursing personnel were most satisfied with the accuracy of test results, phlebotomy courtesy toward patients and nursing staff, and notification of abnormal results. They were least satisfied with stat test turnaround time, laboratory management responsiveness and accessibility, phlebotomy responsiveness to service requests, and routine test turnaround time. The most important aspect of laboratory service reported by nursing personnel was stat test turnaround time. CONCLUSIONS: Most nursing personnel are satisfied with the clinical laboratory services that are provided to the patients in their care. Although test result accuracy is very highly regarded, there is room for improvement in several aspects of service, particularly in test turnaround time and laboratory management accessibility and responsiveness.

Patient safety in anatomic pathology: measuring discrepancy frequencies and causes.

CONTEXT: Anatomic pathology discrepancy frequencies have not been rigorously studied. OBJECTIVE: To determine the frequency of anatomic pathology discrepancies and the causes of these discrepancies. DESIGN: Participants in the College of American Pathologists Q-Probes program self-reported the number of anatomic pathology discrepancies in their laboratories by prospectively performing secondary review (post-sign-out) of 100 surgical pathology or cytology specimens. Reasons for the secondary review included conferences, external review, internal quality assurance policy, and physician request. PARTICIPANTS: Seventy-four laboratories self-reported data. MAIN OUTCOME MEASURES: Frequency of anatomic pathology discrepancy; type of discrepancy (ie, change in margin status, change in diagnosis, change in patient information, or typographic error); effect of discrepancy on patient outcome (ie, no harm, near miss, or harm); and clarity of report. RESULTS: The mean and median laboratory discrepancy frequencies were 6.7% and 5.1%, respectively. Forty-eight percent of all discrepancies were due to a change within the same category of interpretation (eg, 1 tumor type was changed to another tumor type). Twenty-one percent of all discrepancies were due to a change across categories of interpretation (eg, a benign diagnosis was changed to a malignant diagnosis). Although the majority of discrepancies had no effect on patient care, 5.3% had a moderate or marked effect on patient care.Conclusions.-This study establishes a mean multi-institutional discrepancy frequency (related to secondary review) of 6.7%.

Specimen collection volumes for laboratory tests.

CONTEXT: Unnecessary tests, inefficient ordering practices, and collection of more blood than is required for testing contribute to iatrogenic anemia in hospitalized patients. Laboratories accredited by the College of American Pathologists are expected to review phlebotomy practices for specimen collection volumes periodically. OBJECTIVE: To report specimen collection, analytic, and discard volumes for routine laboratory tests and to identify practice variables associated with overcollection and blood wastage. DESIGN: Clinical laboratories participating in the College of American Pathologists Q-Probes laboratory improvement program recorded collection container size, laboratory-defined requested volume, manufacturer-defined analytic volume, and average discard volume for routine complete blood cell counts and electrolyte panels ordered for patients in intensive care units. Participants provided information about their specimen collection, processing, and analytic practices in a questionnaire. SETTING AND PARTICIPANTS: A total of 140 public and private institutions. MAIN OUTCOME MEASURES: Overcollections for routine collections and for situations in which a reduced volume of specimen is collected, and average discard volume per tube. RESULTS: Laboratories collected a median of 2.76 mL (or 8.5 times) more than their instrument's analytic volume for routine complete blood cell counts and 1.75 mL (or 12 times) more than their instrument's analytic volume for routine electrolyte panels. For clinical situations in which reduced collection volumes were necessary, overcollection for the same analytes was 0.5 mL (3 times) and 0.44 mL (4.2 times), respectively. The median discard volume was 2.8 mL/tube for complete blood cell counts and 2.0 mL/tube for electrolyte panels. Specimen collection container size was directly associated with overcollections and discard volumes. Instrument analytic volume was not a determinant of blood wastage. CONCLUSIONS: Most laboratories can decrease collection volumes without compromising the ability of the laboratory to report a reliable and timely result. Use of smaller collection tubes can help reduce blood wastage.