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Information on the Quality Improvement Programme for Histopathology in Ireland, including targets for intradepartmental consultation, turnaround time, frozen section correlation concordance, and frozen section turnaround time. The report includes data analysis and graphs to illustrate trends and progress towards targets.
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Histopathology National Quality Improvement Programme Working Group, RCPI Programme Team
Histopathology National Quality Improvement Programme Steering Committee, HSE OCIO, Prof Leslie Daly
1. Intradepartmental consultation (Q006)
Intradepartmental consultation is where a consultant pathologist seeks a second opinion from another consultant pathologist within his/her department or within his/her regional network on a particular case.
The following targets have been set or updated in Round 2
Histopathology cases (no change from Round 1)
Cytopathology - Exfoliative (updated Round 2)
Cytopathology โ Fine Needle Aspiration (FNA) (updated Round 2) Minimum 3% 3% 7% Achievable 5% 5% 9%
Commentary: Reviewing the data to date indicated a need to set separate Histopathology and Cytopathology targets. The Working Group welcome the overall increase in intradepartmental consultation indicated by the national average below.
Graph 1 Intradepartmental Consultation โ All Hospitals (created July 2016)
Graph 2 Year on year (created July 2016)
0.0%
2.0%
4.0%
6.0%
8.0%
10.0%
12.0%
All Codes P01 P02 P03 P04 P06 P07 No P-Code
Intradepartmental Consultation by P-code
2012 % P06 2013 % P06 2014% P
Graph 3 โ Histology (created July 2016)
2. Turnaround Time
Turnaround time is measured from the time the laboratory receives the specimen to the time the final report is authorised. It is a key monitor for the overall function of the laboratory service, and is considered a critical element of quality because of the impact on clinical management of patients.
This metric is counted in working days.
In this area, TAT targets are set for procedural codes used by the laboratories. The procedural codes used are listed below.
Commentary: Reviewing the data to date indicated no need to change the targets set in Round 1. The Working Group welcomes the overall improvement indicated by the decrease in the national average TAT for P01, P06 and P07. The difference between the total average for cancer centre (purple) and general centre (light blue) is in line with expectations. However they note that:
Code Expansion
P01 Small Biopsy
P02 GI Endoscopic Biopsy
P03 Non Biopsy โ Cancer Resection
P04 Non Biopsy โ Other
P06 Non Gynaecological cytology โ FNA
P07 Non Gynaecological cytology โ Exfoliative
Graph 6 Number of cases by P-Code (created July 2016)
P02 โ GI Endoscopic Biopsy
A GI Endoscopic biopsy is taken during an endoscopic procedure by the gastroenterologist clinician. The processing time for the tissue sample generally takes 2 days. The slide is then ready to be interpreted by the pathologist. Following on from this, some cases may require additional studies, a second opinion from another consultant or further discussion with the referring clinician.
๏ท Target of 80% of cases completed by day 5
Graph 8 (created July 2016)
P03 Non Biopsy - Cancer Resection
These tend to be larger samples including partial resections of organs. The processing time for this tissue sample can take longer, generally 2-3 days. The slide is then ready to be interpreted by the pathologist. Following on from this, some cases may require additional studies, a second opinion from another consultant or further discussion with the referring clinician.
๏ท Target of 80% of cases completed by day 7 Graph 9 (created July 2016)
P06 Non Gynaecological cytology โ FNA
Cytopathology is a branch of pathology that studies and diagnoses diseases on a cellular level. Fine Needle Aspiration involves a needle attached to a syringe to collect cells from lesions or masses in various body organs by micro-coring, often with the application of negative pressure (suction) to increase yield.
The processing time of these samples can be quicker, generally taking 1-2 days. Following on from this, some cases may require additional studies, a second opinion from another consultant or further discussion with the referring clinician.
๏ท Target of 80% of cases completed by day 5
Graph 11 (created July 2016)
P07 โ Non Gynaecological cytology โ Exfoliative
In this method, cells are collected after they have been either spontaneously shed by the body or manually scraped/brushed off of a surface in the body.
The processing time of these samples can be quicker, generally taking 1-2 days. Following on from this, some cases may require additional studies, a second opinion from another consultant or further discussion with the referring clinician.
๏ท Target of 80% of cases completed by day 5
Graph 12 (created July 2016)
4. Frozen Section Deferral
Frozen Section Deferral Deferral rate - This tracks the number of cases where frozen section diagnosis was deferred until final diagnosis was reached on permanent section. This can arise for various reasons, including sample quality, tissue type e.g. Sentinel lymph node, surgical margin analysis is accepted to carry more uncertainty, etc.
Round 2 Target has been set as follows ๏ท 5 % Deferral rate. Note : less than 1% or greater than 10% needs review.
Commentary: Reviewing the data to date indicates that the target set is achievable.
Graph 14 (created July 2016)
5. Frozen Section Turnaround time (TAT)
As for the Turnaround time targets set in Round 1 the time is measured from the time the lab receives the specimen to the time the final report is communicated to the surgeon. It is a key monitor for the overall function of the laboratory service and is considered a critical element of quality because of the impact on clinical management of patients.
In the case of Frozen Section, carried out during surgical procedures this metric is counted in minutes, not working days.
๏ท Target set is 85% of cases to have a TAT of less than or equal to (๏ฃ ) 20 minutes
Commentary: Reviewing the data to date indicates that the target set is ambitious but achievable.
Graph 15 (created July 2016)
6. Adult Autopsy Intradepartmental Consultation
Adult Autopsy includes both Coroner and Non-Coroner autopsies. As in part, Intradepartmental consultation is where a pathologist seeks a second opinion from a colleague within his/her department on a particular case. Pathologists should record the involvement of colleagues, with their agreement, in the NQAIS system and if deemed necessary in the final report. Any review of an autopsy case that occurs prior to authorisation of the final report should be recorded as an intradepartmental consultation.
๏ท Target set is 2% for all adult autopsy cases (coroner & non coroner).
Commentary: Reviewing the data to date indicates that the target set is achievable. The Working Group noted that data is limited to date for this target and may not yet reflect activity in the laboratory. Participants are encouraged to code this activity, and feedback any questions.
Graph 17 (created July 2016)
It is planned to continue to analyse data, consult participants to progress with challenging areas and set targets on the remaining quality activities. A similar report will be published following on from this analysis.
All targets will be reviewed on an annual basis to ensure effectiveness and take into consideration improvements made by individual hospitals.
