Ncn prostate core biopsy reporting audit
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NCN Prostate Core Biopsy Reporting Audit. Dr Ursula Earl NCN Histopath SSG Audit Lead. Methodology. Lab managers asked to complete a datasheet 4 questions One side of A4. Lab Managers’ Data Sheet. Number of cases received between Oct 1 st to Dec 31 st 2013

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Ncn prostate core biopsy reporting audit

NCN Prostate Core Biopsy Reporting Audit

Dr Ursula Earl

NCN Histopath SSG Audit Lead


Methodology
Methodology

  • Lab managers asked to complete a datasheet

  • 4 questions

  • One side of A4


Lab managers data sheet
Lab Managers’ Data Sheet

  • Number of cases received between

    Oct 1st to Dec 31st 2013

  • Histological diagnosis by % type using specific (RCPath) SNOMED code search

  • Turnaround time from date of biopsy taken to date of report authorisation

  • % of cases with immunohistochemistry


Standards final diagnosis
Standards – Final diagnosis

  • % of cases in four diagnostic categories

    (malignant, benign, high grade PIN, suspicious)

  • Re-audit of TRUS prostate biopsy reporting in West Kent comparing data from two trusts with Ontario 2010 data (Bulletin of RCPath April 2012, 158, 95-100)


Standards turnaround times
Standards – Turnaround Times

  • RCPath KPI 6.4 – 80% of cases reported within 7 calendar days, 90% of cases reported within 10 calendar days of biopsy/procedure

  • NHS Improvement: Learning how to achieve a seven day turnaround time in histopathology


Number of cases received
Number of cases received

  • NCN Trust Range 93-200

  • Kent – figures supplied for a 10 month period March – Dec 2010 for Trust A, Trust B & Trusts A & B combined)

  • Kent A - 136.5 in 3 month period

  • Kent B - 43.8 in 3 month period

  • Kent A&B - 233 in 3 month period


Histological diagnosis snomed codes
Histological diagnosis – SNOMED codes

  • Adenocarcinoma (M81403)

  • High grade PIN (M81402)

  • Suspicious (M69760, M69700)

  • Benign (M09450, M09460, M40000, M72000 etc)



Adenocarcinoma diagnosis
Adenocarcinoma Diagnosis

  • NCN Range - 40 – 62%

  • Kent combined - 52.2%

  • Kent A – 55.6%

  • Kent B – 47.2%

  • Ontario – 47%


Kent A

Ontario



Benign diagnosis
Benign Diagnosis

  • NCN range - 34.5 – 47.3%

  • Kent A – 36.7%

  • Kent B - 45.6%

  • Kent com - 40.3%

  • Ontario – 40%



Use of ihc
Use of IHC

  • NCN range - 27% to 82%

  • Kent comb - 30%

  • Kent A – 33%

  • Kent B - 25%



Turnaround time
Turnaround Time

  • KPI 6.4

  • 90% of cases reported within 10 calendar days

  • 80% of cases reported within 7 calendar days

  • NHS IMPROVEMENT

  • 7 day reporting TAT


Tat methodology
TAT - Methodology

  • Some trusts struggled to provide this data because of limitations of their lab computer systems & separation of prostatic core biopsy samples from other prostate specimens




Summary tat
Summary - TAT

  • All trusts meeting the RCPath KPI 6.4 standard of 80% of cases reported within 7 calendar days

  • 6 of 7 trusts meeting the RCPath KPI 6.4 standard of 90% of cases reported within 10 calendar days

  • No trust met NHS Improvement target of 100%, 7 day turnaround


Questions
Questions?

  • Variable use of IHC between trusts

  • Use of suspicious as a diagnostic category

  • Data recording & retrieval on lab computer systems, is Pathosysfullfilling all the audit functions?


Action plan
Action Plan

  • Present findings at NCN Histopath Audit meeting at Evolve, June 10th 2014

  • Send presentation to participating pathologists & lab managers.

  • Individual departments to review their figures & compare with other trusts

  • Root cause analysis if significant discrepancies flagged


Acknowledgements thanks
Acknowledgements & Thanks

Peter Booth, Trudy Johnson, Derek Pace

Jacqui Richards, Sharron Williams,

IanTaylor,, Phil Gibson, Adrienne Mutton,

Paul Barrett, Muhammad Siddiqui,

Matthew Theodosiou, Diane Hemming,

Bob Stirling, Amira El Sharif, Sri Nagarajan


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