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Turnaround Times for Pathology

Key findings

In 2017, 80% of pathology cancer resection reports were received on or before 14 calendar days, which is close to Cancer Care Ontario’s target of 85%. However, there was regional variation in 2017 ranging from 71% to 94%. There also was monthly variation ranging from 68% to 87%.

Measure:  Percentage of cancer resection reports of all disease sites received by Cancer Care Ontario within 14 calendar days of date of surgery

 

Desired Direction:

 

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As of this Report:

 

An image of an arrow pointing straight in a green box. This indicates that there has been no increase or decrease in performance over the previous periods identified and this action is exceeding or meeting target.

What is pathology?

  • Pathology is the medical specialty that examines tissue 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 reporting refers 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 cancer protocols of the College of American Pathologists and the electronic Cancer Checklists (eCC) standard, an internationally-accepted best practice for pathology reporting.
  • Since Cancer System Quality Index (CSQI) 2017, 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, meaning 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.

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 [1]. Pathology reports are used for treatment planning.
  • Cancer Care Ontario receives pathology reports in real time or close to it.
  • The pathology reports from more than 70,000 new cancer patients are sent electronically to Cancer Care Ontario each year from over 115 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 staff [1].

Figure 1. Percentage of resection reports received within 14 calendar days of date of surgery, Ontario, 2017

More information regarding the methodology is available.

Report date: February 2018

Data source: CCO EDW Pathology Datamart

Prepared by: Surveillance and Ontario Cancer Registry

Figure 2. Percentage of resection reports received within 14 calendar days of date of surgery, by Regional Cancer Program (RCP) of pathology lab, 2016 and 2017  

More information regarding the methodology is available.

Report date: February 2018

Data source: CCO EDW Pathology Datamart

Prepared by: Surveillance and Ontario Cancer Registry

Note:

  1. * The decrease in Champlain Regional Cancer Program in 2017 is most likely due to reporting error rather than true pathology turnaround time. Results will be corrected once updated data become available.

Data Table 1. Percentage of resection reports received within 14 calendar days of date of surgery, Ontario, 2017

Specimen taken (month) Indicator value (%) Volume of reports received on or before 14 calendar days Total volume of reports received
January 87.1% 2,717 3,120
February 83.1% 2,428 2,922
March 81.1% 2,435 3,003
April 76.2% 1,925 2,527
May 78.9% 2,588 3,281
June 81.8% 2,677 3,274
July 85.1% 2,292 2,692
August 82.9% 2,377 2,868
September 77.0% 2,284 2,966
October 76.6% 2,396 3,127
November 76.4% 2,365 3,097
December 68.1% 1,670 2,454

Report date: February 2018

Data source: CCO EDW Pathology Datamart

Prepared by: Surveillance and Ontario Cancer Registry

 

    Data Table 2. Percentage of resection reports received within 14 calendar days of date of surgery, by Regional Cancer Program (RCP) of pathology lab, 2016 and 2017

    RCP Indicator value (%) in 2016 Volume of reports received on or before 14 calendar days in 2016 Total volume of reports received in 2016 Lower confidence interval in 2016 Upper confidence interval in 2016 Indicator value (%) in 2017 Volume of reports received on or before 14 calendar days in 2017 Total volume of reports received in 2017 Lower confidence interval in 2017 Upper confidence interval in 2017
    ON 82.8% 30,676 37,065 73.4% 92.1% 79.7% 28,154 35,331 70.3% 89.1%
    ESC 92.0% 1,453 1,579 41.8% 142.3% 89.5% 1,281 1,431 37.2% 141.8%
    SW 86.4% 3,004 3,476 54.2% 118.6% 81.2% 2,612 3,217 48.6% 113.8%
    WW 75.5% 1,035 1,371 26.0% 125.0% 85.1% 1,051 1,235 29.8% 140.4%
    HNHB 81.8% 3,719 4,549 54.5% 109.0% 82.7% 3,708 4,485 55.1% 110.3%
    MHCW 83.1% 3,270 3,933 53.5% 112.8% 79.8% 2,858 3,581 49.3% 110.3%
    TCS 74.6% 3,525 4,728 49.0% 100.1% 72.6% 3,207 4,418 46.4% 98.8%
    TCN 84.1% 2,111 2,509 46.4% 121.9% 73.7% 2,003 2,717 39.7% 107.7%
    Cen 94.8% 2,934 3,094 59.1% 130.6% 93.9% 2,527 2,690 55.6% 132.3%
    CE 74.3% 2,591 3,488 44.4% 104.2% 78.9% 2,584 3,274 47.1% 110.8%
    SE 95.1% 1,269 1,335 39.3% 150.9% 92.1% 1,148 1,247 35.0% 149.1%
    Ch 77.0% 2,994 3,887 48.3% 105.8% 62.0% 2,452 3,958 36.2% 87.7%
    NSM 95.5% 1,120 1,173 35.6% 155.4% 92.6% 1,123 1,213 34.6% 150.6%
    NE 88.2% 1,329 1,507 37.7% 138.7% 90.0% 1,307 1,452 38.0% 142.0%
    NW 73.9% 322 436 0.0% 165.7% 70.9% 293 413 0.0% 164.0%

    Report date: February 2018

    Data source: CCO EDW Pathology Datamart

    Prepared by: Surveillance and Ontario Cancer Registry

    Note:

    1. * The decrease in Champlain Regional Cancer Program in 2017 is most likely due to reporting error rather than true pathology turnaround time. Results will be corrected once updated data become available.

    What do the results show?

    Most 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, 80% of cancer resection reports were completed within the 14-day target (Figure 2). This is relatively unchanged from the previous year.
    • There is monthly variation in the percentage of reports completed within the 14-day target, with the lowest rate in December (68%) and the highest in January (87%) (Figure 1). The decline in December is likely seasonal, and it is anticipated that it will increase in January 2018. 
    • Regional variation was greater than seasonal variation for the past 2 years. In 2017, regional variation ranged from a low of 62% (Champlain) to a high of 94% (Central). Some regions with lower pathology turnaround times may have staffing issues that result 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 for determining patient treatment and outcomes.
    • 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 also has 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 encompassed 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

    • To learn more about Cancer Care Ontario’s Pathology and Laboratory Medicine Program, please visit the CCO website.

    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.