The right test, at the right time, on the right patient, for the by alendar

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									                                         Patient Safety and Quality in
 The right test, at the right time,      Pathology Workshop 2008
on the right patient, for the right      A workshop was held in Canberra on
        clinical condition               6 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
March 2009                               Branch of the Australian Department of
                                         Health and Ageing, in conjunction with the
Welcome to this newsletter about the
                                         QUPC, the National Pathology Accreditation
work and priorities of the Quality Use
                                         Advisory Council (NPAAC) and the Royal
of Pathology Committee (QUPC)
                                         College of Pathologists of Australasia
which oversees the Quality Use of
                                         (RCPA).
Pathology Program (QUPP).
                                         The aims of the 2008 Workshop were to:
In this issue:                           • Provide an update to stakeholders on the
• A report of the 2008 Patient               progress made in the priority areas since
    Safety and Quality Workshop              the initial workshop
• Update on workforce related
    activities                           • Discuss future proposed work and
                                             identify any gaps that need addressing
• Report of the recently completed
    QUPP project “Investigation into     • Provide input to the development of the
    the reasons for incomplete or            pathology quality framework document
    incorrect pathology request          • Further scan the horizon for future issues
    forms” - Royal North Shore               to be addressed.
    Hospital.                            The workshop was attended by health
The QUPP aims to achieve                 consumer representatives, those responsible
improvement in health and economic       for policy, those who write pathology reports
outcomes from the use of pathology in    and those who request, read and use the
health care, through the pursuit of      reports, those who design and build
better practice amongst referrers and    information systems, and clinical and
providers of pathology services and      population researchers.
knowledgeable and engaged                Presentations included:
consumers.                               • Professor David Davies, Anatomical
                                             Pathologist and former President of the
For information on QUPP, QUPC
                                             RCPA – Quality and risk in the practice
and funded projects (completed and
                                             of diagnostic Anatomical Pathology
current) go to
www.health.gov.au/qupp                   • 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            Spotlight on Completed QUPP Project –
    Practitioner – e-Health and            Investigation into the reasons for
    Pathology Services - A Clinician’s     incomplete or incorrect pathology request
    perspective                            forms - Royal North Shore Hospital. The
•   Dr Mark Shephard, Flinders             project employed a mixed methodology
    University, and Ms Janice Gill,        which included a questionnaire, focus group
    Quality Assurance Programs – The       interviews and audits of pathology request
    National Quality Assurance in          forms. The project was undertaken at Royal
    Aboriginal Medical Services Point-     North Shore Hospital, a major teaching
    Of-Care Testing Program                hospital, using the Pacific Laboratory
•   Dr Caroline Laurence, University       Medicine Services (PaLMS) pathology
    of Adelaide – The role of point of     request form.
    care testing in managing chronic
    conditions.                            Issues
                                           The major findings of the report include:
•   Dr Janney Wale, CHF Consumer
    Representative – Pathology and         • An attitude by clinical staff that it was
    Consumers - Can we develop a               not considered necessary to complete a
    partnership approach?                      pathology request form. This applied
                                               particularly to clinical and medication
•   Dr Graeme Suthers, Chair Genetics          details.
    Advisory Committee RCPA –              • Clinical staff do not understand the
    Towards best practice in requesting        impact that incomplete or incorrect
    genetic testing                            pathology request forms have on
•   Dr David Ellis, Chair Structured           laboratory staff.
    Pathology Reporting of Cancer          • The audit of the request forms showed
    Project (Cancer Institute NSW) –           that six sections on the request form
    Update on synoptic reporting for           accounted for about 80% of the errors.
    cancers                                • There are too many sections on the
•   The full report of the workshop            request form that need to be completed.
    is at www.health.gov.au/qupp           • Interns are very good at completing
                                               request forms at the start of their career
                                               with the exception of clinical and
Workforce – the Number One
                                               medication details. However, with time,
Stakeholder Issue!
                                               their error rate increases. This indicates
As a result of the issues raised through
                                               that education and feedback are essential
the pathology workforce scoping
                                               to maintain good clinical practice.
process, three projects are in the
process of development to obtain           • An important finding was the
information about the pathology                considerable amount of time spent by
workforce to assist the various                laboratory staff in finding the
stakeholder groups in developing               information that was missing or incorrect
strategic workforce initiatives                on the request form. Any improvement
necessary to ensure the delivery of            in the completion rate and accuracy of
timely, accessible pathology services.         request forms is going to improve
                                               laboratory productivity.
                                          •   There is a recognised national workforce
QUPP GUIDING ASSUMPTIONS
                                              shortage of specialist pathologists and an
The following assumptions provide a           assumed (but undocumented) shortage of
contextual framework to assist in             appropriately qualified and trained
promoting a strategic approach for            medical laboratory scientists and health
targeting funding at QUPP priorities.         informatics professionals, all of which
                                              has significant potential to affect quality
Pathology requesting                          pathology practice.
• Patterns of requesting practice are
   established early in medical careers   •   Active engagement with the national e-
   (eg university, hospital residency         health agenda (in conjunction with
   and/or early vocational experience)        NPAAC) will ensure best placement for
   and are highly influential on future       influencing the development of useful
   practice patterns.                         infrastructure to support effective and
• Successful strategies require               efficient pathology requesting and
   effective requester engagement for         reporting
   development and implementation.        Consumer engagement
• The best available clinical evidence    • Consumers require convenient, safe
   should be used to construct best         pathology testing that is properly
   practice guidance strategies.            embedded within the process of clinical
• Active engagement with the                care.
   national e-health agenda (in           • Consumers are entitled to good,
   conjunction with NPAAC) will             comprehensible information about the
   ensure best placement for                role of pathology testing in their clinical
   influencing the development of           diagnosis and on-going health care.
   useful infrastructure to support       • People with chronic diseases which
   effective and efficient pathology        require regular pathology testing for their
   requesting and reporting.                management may seek a more focused
Pathology practice                          approach to the management of their
• Funded initiatives must have strong       pathology testing and associated care
   potential for broader application        planning.
   and/or influence on pathology          • Some population groups (such as
   practice.                                Aboriginal and Torres Strait Islander
• Funded initiatives must                   people and/or people living in isolated
   complement and/or expand on the          areas) may require specifically tailored
   national pathology accreditation         access and support strategies.
   framework.                             QUPP promotion
• Pathology professionals have            • There are key messages associated with
   expert knowledge in the rational (ie     quality pathology requesting and practice
   targeted and effective) use of           and their effective promulgation requires
   pathology testing for clinical care      targeted effort.
   but effective systems must be in       • Requesters of pathology testing are
   place to reap the benefit of that        identified as the priority target group for
   knowledge                                dissemination of best practice
.
                                            information.
                        CURRENT FUNDED PROJECTS – May 2009
QUPP Sub-program 1: Quality Consumer Services from a Pathology Perspective

                                                       The Lab Tests Online AustralasianAU website provides
To establish an Australasian version of the Lab
                                                       information on pathology tests performed in Australia,
Tests Online (LTO) website
                                                       both diagnostic and screening, as well as by health
The Australasian Association of Clinical               condition and disease. The website was launched on
Biochemists Inc. Contact Mr Tony Prior:                10 August 2007 with most of the activity now being
tony@aacb.asn.au                                       directed towards increasing the site content and
                                                       communication activities to increase access and
                                                       knowledge of the site.
                                                       http://www.labtestsonline.org.au/
                                                       This project is developing and piloting information
Optimising health benefits with Aboriginal
                                                       strategies to improve the awareness and understanding
People who take Warfarin
                                                       of International Normalised Ratio (INR) testing and
The Royal Australian College of General                promote informed decision participation and consent
Practitioners. Contact Mr Ian Watts:                   among Aboriginal people for its use. The INR is a
ian.watts@racgp.org.au                                 common and important pathology test for monitoring
                                                       the safe use of warfarin drug treatment.

QUPP Sub-program 2: Quality Pathology Referrals
                                                       The main purpose of the Manual is to provide useful
Transformation of the Royal College of
                                                       guidelines for the selection of pathology tests and to
Pathologists of Australasia Manual of Use and          facilitate interpretation of results. This project will
Interpretation of Pathology Tests                      update and transform it as well as create and add a
Royal College of Pathologists of Australasia.          series of evidence based pathology decision support
Contact Dr Tamsin Waterhouse:                          tools (ie diagnostic, monitoring/management and
tamsinw@rcpa.edu.au                                    interpretation guidelines) to inform referring
                                                       practitioners requesting pathology tests for diagnostic
                                                       and monitoring purposes.

                                                       This project is seeking to improve antimicrobial
Improving antimicrobial treatment by selective
                                                       treatment in elderly females by undertaking a controlled
reporting of antibiotic sensitivities – a controlled
                                                       study in asymptomatic bacteriuria using selective
study in elderly females with asymptomatic
                                                       reporting of antibiotic sensitivities. The study aims to
bacteriuria
                                                       demonstrate improved health outcomes as well as
Flinders Medical Centre. Contact                       significant cost savings in patient treatment.
Prof David L Gordon: d.gordon@flinders.edu.au
                                                       This project consists of eight colour supplements
Common Sense Pathology
                                                       distributed with the Australian Doctor magazine, with
Royal College of Pathologists of Australasia.          the objective of educating GPs in the quality use of
Contact Dr Tamsin Waterhouse:                          pathology, using practical case-based scenarios.
tamsinw@rcpa.edu.au

Enhancing the quality use of pathology for GP          This project is undertaking a needs assessment to inform
trainees : Assessing the need                          the development of a training program and series of
                                                       training modules focussed on maximising the uptake of
The University of Adelaide. Contact
                                                       education and training in the quality use of pathology by
Dr Caroline Laurence:
                                                       General Practitioner Registrars and Overseas Trained
caroline.laurence@adelaide.edu.au
                                                       Doctors.
                                                   This project will analyse BEACH (Bettering the
Evidence practice gap in GP pathology test
                                                   Evaluation And Care of Health) data from 2000-2007,
ordering
                                                   incorporating about 240,000 GP pathology tests
The University of Sydney. Contact                  ordered, to compare current practice with evidence and
A/Professor Helena Britt:                          guidelines on test ordering, including a focus on
helenab@med.usyd.edu.au                            national health priority areas. The findings will inform
                                                   future work to improve the quality of pathology
                                                   ordering by GPs.

QUPP Sub-program 3: Quality Pathology Practice
                                                   This project will identify ways in which workload
Workload Audit of Pathology Services
                                                   impacts on professional pathology practice. It will
Royal College of Pathologists of Australasia.      encompass an audit of pathology workload supply and
Contact Dr Debra Graves:                           identify levels at which quality and safety are
debrag@rcpa.edu.au                                 compromised and establish a measure of workload that
                                                   is evidence based.
Structured pathology reporting standards for       This project is developing a process and framework for
cancer                                             the development and dissemination of structured
                                                   pathology reporting standards for six high incidence
Cancer Institute NSW. Contact
                                                   cancers (breast, colorectal, melanoma, lung, prostate
 Professor Jim Bishop:
                                                   and lymphoma), and a toolkit for the development of
jim.bishop@cancerinstitute.org.au
                                                   structured report standards for other cancers.

Evidence-based best practice prevention of blood   This project is developing guidelines for use throughout
borne virus transmission in health care settings   Australia on evidence-based best practice laboratory
                                                   procedures and management of individual cases of
South Eastern Sydney and Illawarra Area Health
                                                   suspected blood-borne virus transmission in health care
Service. Contact Professor William Rawlinson:
                                                   settings.
w.rawlinson@unsw.edu.au



High resolution scanning microscopy for quality    This project will provide high quality digital images for
assurance and educational applications             quality assurance, education, training and continuous
                                                   professional development of pathologists in
RCPA Quality Assurance Programs Pty Limited.
                                                   haematology, cytopathology and microbiology.
Contact Dr Ian Gardner: iang@rcpa.edu.au

Key Incident Monitoring & Management               This project is collating and analysing the type and
Systems (KIMMS)                                    number of incidents in pathology laboratories, with the
                                                   aim of identifying ways to reduce their occurrence and
RCPA Quality Assurance Programs Pty Limited.
                                                   hereby increasing patient safety. The project will tackle
Contact Penny Petinos: pennyp@rcpa.edu.au
                                                   quality assurance problems in the areas of both
                                                   analytical and non-analytical errors.
Improved Pathology Reporting, Education and      This project aims to improve pathology reporting,
Practice (IPREP) for colorectal cancer           education and practice in colorectal cancer. It is
                                                 identifying, designing and piloting the use of synoptic
The University of New South Wales, Contact
                                                 forms and the implementation of colorectal cancer
Dr Sian Hicks: sian.hicks@unsw.edu.au
                                                 reporting protocols.

Identifying how electronic decision support in   This project is identifying how computerised pathology
computerised pathology order entry systems can   order entry systems with varying levels of electronic
improve pathology practice, rational ordering    decision support can enhance the efficiency of
and patient outcomes                             pathology services and lead to more effective and
                                                 rational pathology ordering which in turn may improve
The University of Sydney, Health Informatics,
                                                 patient outcomes.
Research and Evaluation Unit. Contact
Professor Johanna Westbrook:
j.westbrook@usyd.edu.au

								
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