National Data Report 2018 Prof Conor O’Keane Histopathology QI Programme Working Group 14 June 2018

Fifth Annual National Data Analysis Report published Included Round 1, Round 2 and Round 3 Targets/Recommendations, which will be discussed here New Chapters on MDT’s and Addendum Reports, which will be discussed during the later Interactive Panel Discussion session. Report uses Funnel Plots for the first time. Funnel Plots have the ability to present additional layers of easy to interpret information that traditional bar charts cannot Useful way to show comparisons between different centres to identify where there may be special cause variation Report circulated to all Programme Clinical Leads and Local Operational Managers via email To be sent to Hospital Management and Hospital Group Management The National Data Analysis Report should be used as a tool to use to drive reflection on your own local data

New Cover Page and Map of HQI Hospitals

Special stains (& cases) Workload Type No.  (Cases) 2013 No. (Cases) 2014 No. (Cases) 2015 No. (Cases) 2016 No. (Cases) 2017   2013 Workload 2014 Workload 2015 Workload 2016 Workload 2017 Workload Cases 420790 422220 435276 452036 466429 Specimens 664,799 677,462 709,969 750,718 784,034 Blocks 1121696 1142906 1200053 1281374 1323937 All Stains 2,440,966 2,430,030 2,526,534 2,850,511 3,008,483 IHC stains 285,660 (43,865 cases) 285,039 (45,057 cases) 281,551 (49,200 cases) 320439 (55688 cases) 376639 (61804 cases) Routine H&E 1,726,901 (384,524 cases) 1,731,050 (373,116 cases) 1,819,076 (381,144 cases) 2086091 (418164 cases) 2170295 (431903 cases) Extra H&E 286,757 (58,178 cases) 275,874 (58,633 cases) 295,515 (61,701 cases) 304475 (63261 cases) 317584 (63621 cases) Special stains (& cases) 139,102 (56,176 cases) 135,222 (53,822 cases) 127,845 (52,691 cases) 136411 (58275 cases) 141320 (57555 cases) Frozen Section stains 33,991 (1,669 cases) 31,827 (1,573 cases) 28,593 (1,485 cases) 28834 (1398 cases) 29680 (1358 cases) No. of units 33 32 (excludes unit that closed in 2013) 32

Workload

Histopathology Workload Volume in 2017 This dataset gave us 466,429 cases to analyse for 2017. This has increased from 452K cases in 2016 and 435K in 2015. In 2017 we have over 784,034 Specimens, almost 1,323,000 blocks, with over 3,008,483 stains across the 5 stain subgroups Between 2016-2017 the volume of cases nationally increased by 14,393 cases (3.2 %), 42,562 blocks (3.35%) and 47,709 specimens (6.4%). In the five years from 2013 to 2017 the national volume of cases has increased by 45,639 (10.85%), blocks have increased by 202,241 (18%), and the number of specimens examined by 119,235 (18%).

Histopathology Workload Complexity in 2017 The increase in work volume means that individual patients are having more specimens submitted to Pathology each time they attend and these specimens are more complex, requiring more analysis (more blocks of tissue submitted for examination). In the same five years from 2013 to 2017 the national volume of cases requiring Immunohistochemical stains has increased by 40% and the actual number of stains shows a 31% increase. This further reflects the increased complexity of diagnosis and the additional information pathology can provide from tissue samples to guide patient care.

Intradepartmental Consultations (IDC)

Key to graphs & data report Anonymised aggregated data – per data bulletin issued & National Data Report available today. Data reports from now on will run Jan – Dec for the prior year CC: Cancer Centre GC – hospital that is not a cancer centre, can include maternity, children’s, general etc. Red horizontal line: target (min. to be achieved) Green Horizontal Line: target (ideal to be achieved) Dark blue plot line: average of all sites uploaded Purple plot line: average of all CC data uploaded Pale blue plot line: average of all GC data uploaded

Funnel Plots Funnel Plots have the ability to present additional layers of easy to interpret information that traditional bar charts cannot Makes it easier to identify outliers relative to other data points 99.7% of instances should fall within the outer control limits 95% 99.7% unusual Usual μ = Population mean σ = Population standard deviation

Intradepartmental Consultations

Funnel Plot % IDCs per case no.’s 2017

Histology IDC per site 2017 v 2016 2016 Data 2017 Data P-Codes P01-P04 2016 IntraD - Histology   2017 IntraD - Histology No. of Cases No. Q006 % Q006 Cancer Centres 210117 14932 7.11% 218539 14599 6.68% CC1 35399 3546 10.02% 37108 3078 8.29% CC2 30526 1610 5.27% 33001 1263 3.83% CC3 27463 1482 5.40% 27808 1671 6.01% CC4 34801 1388 3.99% 36251 1499 4.14% CC5 18049 1202 6.66% 19045 1488 7.81% CC6 26986 1908 7.07% 27087 1654 6.11% CC7 15352 1652 10.76% 15783 1664 10.54% CC8 21541 2144 9.95% 22456 2282 10.16% General Centres 199580 9666 4.84% 205307 8998 4.38% GC1 851 51 5.99% 864 80 9.26% GC2 7021 347 4.94% 6783 335 GC3 3074 26 0.85% 3026 1 0.03% GC4 6099 275 4.51% 6668 207 3.10% GC5 2690 221 8.22% 3046 135 4.43% GC7 19851 756 3.81% 19969 781 3.91% GC8 14162 736 5.20% 14578 630 4.32% GC9 14444 668 4.62% 15477 457 2.95% GC10 12026 617 5.13% 11208 494 4.41% GC11 7683 1233 16.05% 7686 1030 13.40% GC12 6255 160 2.56% 5901 233 3.95% GC13 8281 357 4.31% 8054 272 3.38% GC15 7088 404 5.70% 7387 391 5.29% GC16 4196 445 10.61% 4617 589 12.76% GC17 0.00% GC19 4764 348 7.30% 4682 225 4.81% GC20 6092 74 1.21% 6172 57 0.92% GC23 10378 235 2.26% 12218 302 2.47% GC24 23488 475 2.02% 23038 425 1.84% GC25 9455 304 3.22% 10255 621 6.06% GC27 9976 1296 12.99% 10230 997 9.75% GC28 15823 544 3.44% 17688 635 3.59% GC29 1339 14 1.05% 1224 11 0.90% GC30 4544 1.76% 4536 90 1.98% All Sites 409697 24598 6.00% 423846 23597 5.57%

Intradepartmental Consultations - Non Gynae Cytology FNA (P06) 2013-2017

Intradepartmental Consultations - for non gynaecological cytology – FNA. Site data. P-Code P07 2016 IntraD - Non Gynaecological Cytology Exfoliative 2017 IntraD - Non Gynaecological Cytology Exfoliative   No. of Cases No. Q006 % Q006 Cancer Centres 14696 587 3.99% 14134 534 3.78% CC1 3114 135 4.34% 3359 118 3.51% CC2 1566 136 8.68% 1740 81 4.66% CC3 3785 46 1.22% 2994 40 1.34% CC4 2044 45 2.20% 2063 37 1.79% CC5 837 5.50% 955 58 6.07% CC6 526 52 9.89% 556 55 CC7 1059 127 11.99% 1051 145 13.80% CC8 1765 0.00% 1416 General Centres 8461 418 4.94% 8455 448 5.30% GC1 GC2 GC3 66 98 GC4 GC5 141 2 1.42% 173 1 0.58% GC7 610 31 5.08% 584 34 5.82% GC8 1100 30 2.73% 976 23 2.36% GC9 470 22 4.68% 499 11 GC10 444 6.98% 523 29 5.54% GC11 385 100 25.97% 368 60 16.30% GC12 1109 3 0.27% 993 15 1.51% GC13 291 20 6.87% 382 3.93% GC15 359 8.08% 343 10.79% GC16 341 8.80% 367 32 8.72% GC17 GC19 GC20 72 GC23 756 1.46% 855 5.38% GC24 1328 16 1.20% 1239 26 2.10% GC25 361 4.16% 309 24 7.77% GC27 178 47 26.40% 184 32.61% GC28 241 9.54% 228 11.40% GC29 GC30 208 8 3.85% 274 9 3.28% All Sites 23157 1005 22589 982 4.35%

Intradepartmental Consultations - Non Gynaecological Cytology Exfoliative (P07) 2013-2017  

IDC – Non Gynaecological Cytology –Exfoliative. Site data.

Intradepartmental Consultations - Autopsy

Intradepartmental Consultations - Autopsy 2016 Data 2017 Data P-Codes P01-P04 2016 IntraD - Adult Autopsy   2017 IntraD - Adult Autopsy No. of Cases No. Q006 % Q006 Cancer Centres 1033 31 3.00% 1083 19 1.75% CC1 49 0.00% 50 CC2 69 1 1.45% 64 2 3.13% CC3 130 14 10.77% 47 3 6.38% CC4 189 1.59% CC5 222 1.35% 183 1.09% CC6 459 466 0.43% CC7 104 13 12.50% 84 7 8.33% CC8 General Centres 1971 27 1.37% 36 1.83% GC1 11 6 54.55% 4 30.77% GC2 GC3 71 35 GC4 55 5 9.09% 12 GC5 21 29 GC8 166 181 0.55% GC10 895 874 GC17 142 18 12.68% GC24 376 16 4.26% 329 3.34% GC25 193 221 GC27 135 1.48% All Sites 3004 58 1.93% 3054 1.80%

Multi Departmental Team Review

MDT Agreement Small Biopsy (P01)

Funnel plot- Histology P01 % MDT agreement - by cases per site

MDT Agreement GI Endoscopic Biopsy (P02)

Funnel Plot of Histology GI Endoscopic Biopsy (P02) % MDT Agreement by Site Cases

MDT Agreement Non Biopsy Cancer Resection (P03)

Histology Non-Biopsy Cancer Resection % MDT Agreement by no Histology Non-Biopsy Cancer Resection % MDT Agreement by no. of site cases

MDT Agreement Non Biopsy Other (P04)

Histology non-biopsy Other % MDT Agreement by Site Cases 2017

Addendum Reports

AMENDED REPORTS – Q021 A change to the pathologic interpretation occurs that may give rise to a change in treatment/prognosis1 CORRECTED REPORTS – Q022 A transcription or identification error, without a change to the diagnostic information1 SUPPLEMENTARY REPORTS – Q020 A report issued when new information becomes available after the final report has been submitted1 1 Monitoring Error in Histopathology – A Multi-Institutional Audit of Addendum Reports, USCAP Vancouver 2018, S.Phelan et al

All Histology% Combined Amended/Corrected Reports per Quarter 2016-2017

Histology only, % Combined Amended/Corrected Reports by number of cases per site 2017

Histology only % Combined Amended/Corrected Reports 2017 v 2016

Amended/Corrected Reports -All Cytology (P05-P09)

Cytology only, % Combined Amended/Corrected Reports by number of cases per site 2017

Cytology Only Amended/Corrected Reports 2017/2016

Turnaround Times

Turnaround Times – Small Biopsy Quarterly 2012-2017

Turnaround Times – Small Biopsy 2017 v 2016

Turnaround Times - GI Endoscopic Biopsy- 2012-2017 Quarterly

Turnaround Time GI Endoscopic Biopsy. Funnel Plot  

Turnaround Times - GI Endoscopic Biopsy

Turnaround Times - Non Biopsy Cancer Resection (P03) 2012-2017

Turnaround Times – Non Biopsy Cancer Resection 2017 v 2016

Turnaround Times – Non Biopsy Other Quarterly 2012-2017

Turnaround Times – Non Biopsy Other 2017 v 2016

Turnaround Times – Non Gynaecological Cytology FNA 2012-2017 Quarterly

Turnaround Times – Non Gynaecological Cytology FNA 2017 v 2016

Turnaround Times – Non Gynaecological Cytology Exfoliative 2012-2017 Quarterly

Turnaround Times - Non Gynaecological Cytology Exfoliative

TAT Summary In 2017 nationally, we met the 80% Completed Day 5 Target for: Non Gynaecological Cytology FNA (P06) cases and Non Gynaecological Cytology Exfoliative (P07) cases. However in 2017 nationally, we did not meet the 80% Completed Day 5 Target for: Small Biopsy (P01) cases GI Endoscopic Biopsy (P02) Non Gynaecological Cytology FNA (P06) cases. Additionally nationally we did not meet the 80% Completed Day 7 Target for: Non Biopsy Cancer Resection (P03) cases Non Biopsy Other (P04) cases. This is likely related to challenges around staffing in histopathology laboratories and recruitment and retention of Consultant Histopathologists.

Frozen Section Correlation and Turnaround Time

Frozen Section Concordance per quarter 2012-2017

Frozen Section Concordance. 2017 v 2016 .

FROZEN SECTION CORRELATION DEFERRAL RATE (Q008). Quarterly 2012-2017

Frozen Section Turnaround Time Quarterly 2012-2017

Frozen Section Turnaround Time 2017 v 2016