Quality Use of Pathology
QUPP Newsletter March 2009
Newsletters are published periodically about the work and priorities of the Quality Use of Pathology Committee (QUPC) which oversees the Quality Use of Pathology Program (QUPP)
The right test, at the right time, on the right patient, for the right clinical condition
PDF printable version of QUPP Newsletter March 2009 (PDF 111 KB)
March 2009
Welcome to this newsletter about the work and priorities of the Quality Use of Pathology Committee (QUPC) which oversees the Quality Use of Pathology Program (QUPP).In this issue:
- A report of the 2008 Patient Safety and Quality Workshop
- Update on workforce related activities
- Report of the recently completed QUPP project “Investigation into the reasons for incomplete or incorrect pathology request forms” - Royal North Shore Hospital.
- QUPP Guiding Assumptions
For information on QUPP, QUPC and funded projects (completed and current) go to www.health.gov.au/qupp
Patient Safety and Quality in Pathology Workshop 2008
A workshop was held in Canberra on6 November. It was a follow up to the successful workshop held in November 2007.
The Workshop was convened by the Pathology Section in the Diagnostic Services Branch of the Australian Department of Health and Ageing, in conjunction with the QUPC, the National Pathology Accreditation Advisory Council (NPAAC) and the Royal College of Pathologists of Australasia (RCPA).
The aims of the 2008 Workshop were to:
- Provide an update to stakeholders on the progress made in the priority areas since the initial workshop
- Discuss future proposed work and identify any gaps that need addressing
- Provide input to the development of the pathology quality framework document
- Further scan the horizon for future issues to be addressed.
Presentations included:
- Professor David Davies, Anatomical Pathologist and former President of the RCPA – Quality and risk in the practice of diagnostic Anatomical Pathology
- Professor Leslie Burnett, Chair National Pathology Accreditation Advisory Council – Key findings from the Key Incident Monitoring & Management Systems (KIMMS) project
- Mr Dean Meston, NeHTA Pathology – e-Pathology – next steps.
- Dr Christopher Wagner, NeHTA Clinical Leader and General Practitioner – e-Health and Pathology Services - A Clinician’s perspective
- Dr Mark Shephard, Flinders University, and Ms Janice Gill, Quality Assurance Programs – The National Quality Assurance in Aboriginal Medical Services Point-Of-Care Testing Program
- Dr Caroline Laurence, University of Adelaide – The role of point of care testing in managing chronic conditions.
- Dr Janney Wale, CHF Consumer Representative – Pathology and Consumers - Can we develop a partnership approach?
- Dr Graeme Suthers, Chair Genetics Advisory Committee RCPA – Towards best practice in requesting genetic testing
- Dr David Ellis, Chair Structured Pathology Reporting of Cancer Project (Cancer Institute NSW) – Update on synoptic reporting for cancers
Workforce – the Number One Stakeholder Issue!
As a result of the issues raised through the pathology workforce scoping process, three projects are in the process of development to obtain information about the pathology workforce to assist the various stakeholder groups in developing strategic workforce initiatives necessary to ensure the delivery of timely, accessible pathology services.Spotlight on Completed QUPP Project
Investigation into the reasons for incomplete or incorrect pathology request forms - Royal North Shore Hospital. The project employed a mixed methodology which included a questionnaire, focus group interviews and audits of pathology request forms. The project was undertaken at Royal North Shore Hospital, a major teaching hospital, using the Pacific Laboratory Medicine Services (PaLMS) pathology request form.To view the full report of this project go to QUPP - Report Royal North Shore (PDF 863 KB)
Issues
The major findings of the report include:- An attitude by clinical staff that it was not considered necessary to complete a pathology request form. This applied particularly to clinical and medication details.
- Clinical staff do not understand the impact that incomplete or incorrect pathology request forms have on laboratory staff.
- The audit of the request forms showed that six sections on the request form accounted for about 80% of the errors.
- There are too many sections on the request form that need to be completed.
- Interns are very good at completing request forms at the start of their career with the exception of clinical and medication details. However, with time, their error rate increases. This indicates that education and feedback are essential to maintain good clinical practice.
- An important finding was the considerable amount of time spent by laboratory staff in finding the information that was missing or incorrect on the request form. Any improvement in the completion rate and accuracy of request forms is going to improve laboratory productivity.
QUPP GUIDING ASSUMPTIONS
The following assumptions provide a contextual framework to assist in promoting a strategic approach for targeting funding at QUPP priorities.Pathology requesting
- Patterns of requesting practice are established early in medical careers (eg university, hospital residency and/or early vocational experience) and are highly influential on future practice patterns.
- Successful strategies require effective requester engagement for development and implementation.
- The best available clinical evidence should be used to construct best practice guidance strategies.
- Active engagement with the national e-health agenda (in conjunction with NPAAC) will ensure best placement for influencing the development of useful infrastructure to support effective and efficient pathology requesting and reporting.
Pathology practice
- Funded initiatives must have strong potential for broader application and/or influence on pathology practice.
- Funded initiatives must complement and/or expand on the national pathology accreditation framework.
- Pathology professionals have expert knowledge in the rational (ie targeted and effective) use of pathology testing for clinical care but effective systems must be in place to reap the benefit of that knowledge
- There is a recognised national workforce shortage of specialist pathologists and an assumed (but undocumented) shortage of appropriately qualified and trained medical laboratory scientists and health informatics professionals, all of which has significant potential to affect quality pathology practice.
- Active engagement with the national e-health agenda (in conjunction with NPAAC) will ensure best placement for influencing the development of useful infrastructure to support effective and efficient pathology requesting and reporting
Consumer engagement
- Consumers require convenient, safe pathology testing that is properly embedded within the process of clinical care.
- Consumers are entitled to good, comprehensible information about the role of pathology testing in their clinical diagnosis and on-going health care.
- People with chronic diseases which require regular pathology testing for their management may seek a more focused approach to the management of their pathology testing and associated care planning.
- Some population groups (such as Aboriginal and Torres Strait Islander people and/or people living in isolated areas) may require specifically tailored access and support strategies.
QUPP promotion
- There are key messages associated with quality pathology requesting and practice and their effective promulgation requires targeted effort.
- Requesters of pathology testing are identified as the priority target group for dissemination of best practice information.
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