Benchmarking in Anatomic Pathology

Inter-Institutional Comparison of Frozen Section Turnaround Time
RATIONALE: CAP Laboratory Accreditation Program Inspection Checklist (1994) Question 08.1170

“the critical interval for preparing and having frozen sections ready for review as 15 minutes, measured from the time the specimen is received by the pathologist to the time the slide is available for interpretation”

RESULTS:Laboratory Practices of Participating Institutions

Laboratory Practice % of Institutions

<300 Beds >300 Beds

Schedule FS N=506 N=148

Yes 68 57

No 32 43

Call FS from: N=502 N=148

OR, Other 96 97

Specimen arrives 4 3

Call FS to: N=503 N=146

Path Dept, Lab, 66 70

Pathologist/ staff 34 30

OBJECTIVESMeasure intra-operative frozen section turnaround time

Examine practice variables that influence frozen section turnaround time.

RESULTSLaboratory Practices of Participating Institutions Laboratoary Practice % of Institutions

<300 Beds 300 Beds

Staffing (>1 resp.) N=507 N=148

Full time 91 100

Part time, Other 18 7

FS technical staff 34 30

Monitor FS TAT N=508 N=147

Yes 20 25

No 80 75

Cryoat temp alarm N=504 N=148

Yes 21 31

No 79 69

MAIN OUTCOME MEASURES 

Individual Benchmark

–Aggregate 90% FS (receipt to report) block completion time

Institutional Benchmark

— Percentage of outlier FS block TATs

RESULTS Demographic Characteristics of Participating InstitutionsDemographic Characteristic % of Institutions

<300 Beds >300 Beds

Hospital location

City 50 87

Suburban, Rural 50 13

Institution type

Private, nonprofit 68 57

Priv. profit, Gov’t 32 43

Teaching program 16 75

JCAHO accred. 79 69

CAP accreditation 78 77

STUDY DESIGNProspective FS TAT / 4 months

30 inpatient cases / 4 specimens/case

Questionnaires profiling FS practice characteristics

RESULTS Frozen Section Block Turnaround Time Performance by Individual Pathologists (Minutes) Expressed in Percentiles N=32,868 FS Blocks

10th 25th 50th 75th 90th

4 7 10 15 20

STUDY DESIGN — (Aggregate data) Record for each case: Turnaround time Number of blocks

Reason for FS request Tissue type

Ancillary procedures Technical problems

#/type personnel preparing FS Wait for the tissue

# pathologists examining FS Simultaneous FS

RESULTS: Frozen Section 90% Block Turnaround Time Performance by Institutions (minutes) Expressed in Percentiles Percentiles

Bed Size N 10th 25th 50t 75th 90th

<150 305 12 15 17 21 25

151-300 201 12 15 18 21 26

>300 147 13 15 20 24 30

All 695 12 15 18 22 26

PARTICIPANTS: 700 institutions: North America (667), Australia (12), New Zealand (1), United Kingdom (3), Hong Kong (1), Mexico (1),Norway (1) RESULTS: Percent of OutliersAggregate 8.3%

Institutional 30%

STUDY DESIGN — Institutional DataDemographics Surg. path./FS case volumes

Staffing levels FS scheduling

FS communication Travel time to FS area

Cryostat features FS TAT goals

Freezing & staining techniques

RESULTS Percent of FS Block Turnaround Time Outliers Expressed in Percentiles Bed Size Percentiles

10th 90th

<300 0 % 20%

>300 0 % 26%