RE-AUDIT OF HEAD AND NECK POST OPERATIVE HISTOPATHOLOGY SPECIMENS TURN AROUND TIMES DEPARTMENT OF CELLULAR PATHOLOGY AND MAXILLOFACIAL SURGERY DERRIFORD HOSPITAL, PLYMOUTH DR OLUTAYO AKINBOBUYI (SHO) DR TIM BRACEY(CONSULTANT HISTOPATHOLOGIST) November 2016

GUIDELINES Royal College of pathologist - (Datasets and Tissue Pathways) www.rcpath.org/publications- media/publications/datasets/datasets-TP.htm -Key Performance Indicators as published by the RCPath(May 2011, Re issued April 2013) National Institute for Health and Care Excellence(NICE Guidelines)

BACKGROUND KPI: Overall Histopathology reporting turnaround times (RCPath) 80% of all Histopathology and diagnostic cytology cases reported, confirmed, electronically issued and electronically available within 10 working days of resection or procedure. 80% of bony specimens requiring decalcification should be reported within 21 days. Sawing the specimens in thin slices prior to decalcification can reduce processing times.

Aim and Objectives To evaluate the range of postoperative head and neck histopathology specimens turn- around times To evaluate the impact of the newly acquired (Pathology Exakt) bone saw on the turn around time for bony resections.

METHODS Retrospective Audit Sample Size(2015): 89 Post operative head and neck specimens between January 2013- December 2014. Sample Size(2016): 20 Post operative head and neck specimens between August 2015-July 2016 Specimens Excluded: FNACs Non surgical pathology; Lymphomas and benign diseases.

RESULTS 2016 Salivary gland CLINICAL SITE TOTAL SPECIMEN REPORTED =/< 10 DAYS RANGE TAT(DAYS) AVERAGE TAT(DAYS Salivary gland 2 6- 8 7 Neck Dissections 8 5 3- 13 9 Tonsil/Oropharynx 4 12- 13 12 Bony Specimen Total Reported =/< 21days Range Average Maxilla/mandible 6 3 11-29 19

RESULTS 2015 Salivary gland CLINICAL SITE TOTAL SPECIMEN REPORTED =/< 10 DAYS RANGE TAT(DAYS) AVERAGE TAT(DAYS Salivary gland 20 17 2-22 8 Neck Dissections 12 7-26 13 Tonsil/Oropharynx 45 36 2-29 11 Bony Specimen Total Reported =/< 21days Range Average Maxilla/mandible 12 6 14-60 26

RESULTS 2016 2015 RCPath

CONCLUSION There was remarkable improvement in TATs for salivary gland and neck specimens. Turn around times for bony resections remained unchanged although there was a significant improvement in range. There was a significant decline in TATs for tonsillar/oropharyngeal specimen with improvement noted in the range of TATs. There were reduced numbers of specimens in 2016 c/w 2015 numbers may be incorrect due to coding inaccuracy

RECOMMENDATION 2016 The bone saw should be used for jaw specimens and batching should be avoided if it affects TATs negatively Ultrasonic decalcification device can be used to complement the bone saw. More staff to be trained on how to use equipment Avoid build up of specialist specimens (? BMS cutup) Re-audit in 12/24 months to be organised by TB