Transcript Histological diagnosis – SNOMED codes

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

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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
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Number of cases
NUMBER OF CASES OCT 1st - Dec 31st 2013
250
200
150
Number of cases
100
50
0
Histological diagnosis – SNOMED codes
Adenocarcinoma (M81403)
 High grade PIN (M81402)
 Suspicious (M69760, M69700)
 Benign (M09450, M09460, M40000,
M72000 etc)

% of cases by diagnostic category
70
60
50
Malignant %
40
High grade PIN %
Suspicious %
30
Benign %
20
10
0
South Tees
North Tees
CDDFT
Gateshead Northumbria Sunderland
RVI
Adenocarcinoma Diagnosis
NCN Range  Kent combined  Kent A –
 Kent B –
 Ontario –

40 – 62%
52.2%
55.6%
47.2%
47%
% of m alignant cases
70
60
Kent A
% of cases
50
Ontario
40
30
20
10
0
South Tees
North Tees
CDDFT
Gateshead
Northumbria
Sunderland
RVI
% of cases high grade PIN or suspicious
20
18
16
12
Suspicious %
10
High grade PIN %
8
6
4
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% of cases
14
Benign Diagnosis
NCN range - 34.5 – 47.3%
 Kent A –
36.7%
 Kent B 45.6%
 Kent com - 40.3%
 Ontario –
40%

% of cases with benign diagnosis
60
50
% of caes
40
Kent A
30
Benign %
20
10
0
South Tees
North Tees
CDDFT
Gateshead
Northumbria
Sunderland
RVI
Use of IHC
NCN range - 27% to 82%
 Kent comb - 30%
 Kent A –
33%
 Kent B 25%

% of cases with IHC
90
80
70
% of cases
60
50
IHC %
40
30
20
10
0
South Tees
North Tees
CDDFT
Gateshead
Northumbria
Sunderland
RVI
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
100
90
80
70
TAT <7
60
TAT 7
50
TAT >7
40
TAT >10
30
20
10
0
South Tees
North Tees
CDDFT
Gateshead Northumbria Sunderland
RVI
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
Achieving a 7 day TAT
120
100
80
TAT >7 days
60
TAT <=7 days
40
20
0
South Tees
North Tees
CDDFT
Gateshead Northumbria Sunderland
RVI
Achieving a 90% 10 day TAT
<10 day TAT
120
% of cases reported
100
80
60
<10 day TAT
40
20
0
South Tees
North Tees
CDDFT
Gateshead Northumbria Sunderland
RVI
100
90
80
% of cases reported
70
60
TAT <=7 days
50
TAT >7 days
TAT >10
40
30
20
10
0
South Tees
North Tees
CDDFT
Gateshead Northumbria Sunderland
RVI
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

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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