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
0
50
100
150
200
250
Nu
mb
er o
f ca
ses
Number of cases
Histological diagnosis – SNOMED codes
Adenocarcinoma (M81403) High grade PIN (M81402) Suspicious (M69760, M69700) Benign (M09450, M09460, M40000,
M72000 etc)
0
10
20
30
40
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60
70
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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10
20
30
40
50
60
70
South Tees North Tees CDDFT Gateshead Northumbria Sunderland RVI
% o
f ca
ses
Kent A
Ontario
% of cases high grade PIN or suspicious
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2
4
6
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20
% 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%
0
10
20
30
40
50
60
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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10
20
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40
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70
80
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
0
10
20
30
40
50
60
70
80
90
100
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
0
20
40
60
80
100
120
South Tees North Tees CDDFT Gateshead Northumbria Sunderland RVI
TAT >7 days
TAT <=7 days
<10 day TAT
0
20
40
60
80
100
120
South Tees North Tees CDDFT Gateshead Northumbria Sunderland RVI
% o
f cases r
ep
ort
ed
<10 day TAT
Achieving a 90% 10 day TAT
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10
20
30
40
50
60
70
80
90
100
South Tees North Tees CDDFT Gateshead Northumbria Sunderland RVI
% o
f cases r
ep
ort
ed
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