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 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

% 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

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

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

NUMBER OF CASES OCT 1st - Dec 31st 2013

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Nu

mb

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Number of cases

Histological diagnosis – SNOMED codes

Adenocarcinoma (M81403) High grade PIN (M81402) Suspicious (M69760, M69700) Benign (M09450, M09460, M40000,

M72000 etc)

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South Tees North Tees CDDFT Gateshead Northumbria Sunderland RVI

Malignant %

High grade PIN %

Suspicious %

Benign %

% of cases by diagnostic category

Adenocarcinoma Diagnosis

NCN Range - 40 – 62% Kent combined - 52.2% Kent A – 55.6% Kent B – 47.2% Ontario – 47%

% of malignant cases

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70

South Tees North Tees CDDFT Gateshead Northumbria Sunderland RVI

% o

f ca

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Kent A

Ontario

% of cases high grade PIN or suspicious

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% o

f cases

Suspicious %

High grade PIN %

Benign Diagnosis

NCN range - 34.5 – 47.3% Kent A – 36.7% Kent B - 45.6% Kent com - 40.3% Ontario – 40%

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South Tees North Tees CDDFT Gateshead Northumbria Sunderland RVI

% o

f caes

Benign %

% of cases with benign diagnosis

Kent A

Use of IHC

NCN range - 27% to 82% Kent comb - 30% Kent A – 33% Kent B - 25%

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90

South Tees North Tees CDDFT Gateshead Northumbria Sunderland RVI

% o

f cases

IHC %

% of cases with IHC

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

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

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TAT <7

TAT 7

TAT >7

TAT >10

TAT <7 78.5 88 84 78 76 52 76.33

TAT 7 9.5 2.8 7 7 8 12 9.92

TAT >7 12 4.6 8 14 8.8 9 9.16

TAT >10 2.5 4.6 2 2 7.2 26 4.58

South Tees North Tees CDDFT Gateshead Northumbria Sunderland RVI

Achieving a 7 day TAT

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40

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80

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120

South Tees North Tees CDDFT Gateshead Northumbria Sunderland RVI

TAT >7 days

TAT <=7 days

<10 day TAT

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South Tees North Tees CDDFT Gateshead Northumbria Sunderland RVI

% o

f cases r

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<10 day TAT

Achieving a 90% 10 day TAT

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South Tees North Tees CDDFT Gateshead Northumbria Sunderland RVI

% o

f cases r

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TAT <=7 days

TAT >7 days

TAT >10

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?

Variable use of IHC between trusts Use of suspicious as a diagnostic category Data recording & retrieval on lab computer

systems, is Pathosys fullfilling all the audit functions?

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

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