Turnaround Times for Pathology

Key findings

In 2016, 83% of cancer resection pathology reports were received on or before 14 days, which is close to Cancer Care Ontario’s target of 85%. However, regional variation ranges from 74% to 96%, and monthly variation ranges from 76% to 86%.

Measure	Desired Direction	As of this Report
Percent of cancer resection reports of all disease sites received by Cancer Care Ontario within 14 calendar days from date of surgery
See Methodology and Approach to find out how the ratings are calculated.

What is pathology?

• Pathology is the medical specialty that examines tissues and cells under a microscope to diagnose the type and severity of disease.
• Almost all cancer patients begin their involvement with the cancer system through a series of diagnostic tests. Some of these tests involve removing tissue or cells so they can be examined.
• Since cancer treatment decisions are based on the pathology diagnosis, the quality of pathology reports is extremely important. A misdiagnosis or misinterpretation of the findings can result in unnecessary, harmful or wrong treatment.

What is synoptic and narrative pathology reporting?

• Synoptic pathology reports refer to a standardized electronic report in a discrete data field format (i.e. each type of information has a specific place and format in the report). It is meant to improve the quality and reliability of pathology reports. In Ontario, synoptic cancer pathology reports are standardized according to the College of American Pathologists cancer protocols and the electronic Cancer Checklists (eCC) standard, an internationally accepted best practice for pathology reporting.
• This year, narrative pathology reporting has been included in the turnaround time measure. Narrative reports capture the observations and findings of the pathological examination but are unstructured; the form and content may vary between pathologists. Narrative reports have been included to simplify the turnaround time metric and include all cancer resected cases. Due to the change in methodology, results from this year are unable to be compared to previous years.

What is turnaround time for pathology?

• Turnaround time is measured by the percentage of cancer resection reports received electronically by Cancer Care Ontario within 14 calendar days of the date of surgery.
• Patients, clinicians and pathologists have identified turnaround time as a key element in the evaluation of quality in surgical pathology . Pathology reports are used for treatment planning.
• Cancer Care Ontario receives pathology reports in real time or near to real time.
• The pathology reports from more than 70,000 new cancer patients each year are sent electronically to Cancer Care Ontario from 116 acute-care hospitals and more than 400 pathologists. Several factors affect turnaround time, including specimen volume, pathology laboratory operations and the number of pathologists and support staff¹.

What do the results show?

Eighty-three percent (83%) of cancer resection reports were completed within the 14-day target in Ontario, but regional and seasonal variation exists (Figures 1 and 2).

• At the provincial level, 83% of cancer resection reports were completed within the 14-day target seen in Figure 2.
• When looking at the percentage of reports completed within target by month, variation is seen with the lowest rate (76%) in December and the highest (86%) in January (Figure 1). The decline for the month of December is likely seasonal and it is anticipated that it will increase in January 2017.
• Figure 2 highlights that regional variation was greater than seasonal variation, with North West having 74% of cancer resection reports completed within the 14-day target, compared to 96% in North Simcoe Muskoka. Some regions with lower pathology turnaround times may have staffing issues resulting in delays.

Why is this important to patient care?

Timeliness is an important component of quality and positive patient outcomes.

• Pathology diagnosis is the cornerstone to determine patient treatment and outcome.
• Accuracy, timeliness, usability and completeness are the hallmarks of quality pathology.
• A focus on timeliness will ensure that pathologists have the resources needed to complete reports in a timely manner.
• Cancer Care Ontario has measured wait times in cancer surgery, radiation and systemic treatment for almost a decade, leading to increased resourcing and improved efficiencies. This, in turn, has resulted in more timely treatment.
• Cancer Care Ontario has also emphasized the importance of measuring wait times in relation to the entire patient journey. Pathologic assessment of cancer specimens is a critical component of the journey, and measuring pathology turnaround time aligns with that goal.
• The surgical pathology turnaround time was introduced as a performance management measure in April 2013. As of April 2014, surgical pathology turnaround time encompasses all disease sites that are reported in synoptic and narrative format. This change allows hospitals and regions to better understand, highlight and address system and resource gaps.

Find out more

Learn more about Cancer Care Ontario’s Pathology and Laboratory Medicine Program.

View Notes

1. Zarbo RJ, Gephardt GN, Howanitz PJ. Intralaboratory timeliness of surgical pathology reports: results of two College of American Pathologists q-probes studies of biopsies and complex specimens. Arch Pathol Lab Med. 2000; 120:234–44.