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

2. 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
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

3. New Cover Page and Map of HQI Hospitals

4. 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
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)
(55688 cases)
(61804 cases)
Routine H&E
1,726,901 (384,524 cases)
1,731,050 (373,116 cases)
1,819,076 (381,144 cases)
( cases)
( cases)
Extra H&E
286,757 (58,178 cases)
275,874 (58,633 cases)
295,515 (61,701 cases)
(63261 cases)
(63621 cases)
Special stains (& cases)
139,102 (56,176 cases)
135,222 (53,822 cases)
127,845 (52,691 cases)
(58275 cases)
(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

5. Workload

6. Histopathology Workload Volume in 2017
This dataset gave us 466,429 cases to analyse for 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 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%).

7. 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.

8. Intradepartmental Consultations (IDC)

9. 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

10. 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

11. Intradepartmental Consultations

12. Funnel Plot % IDCs per case no.’s 2017

13. 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%

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

15. 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%

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

17. IDC – Non Gynaecological Cytology –Exfoliative. Site data.

18. Intradepartmental Consultations - Autopsy

19. 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%

20. Multi Departmental Team Review

21. MDT Agreement Small Biopsy (P01)

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

23. MDT Agreement GI Endoscopic Biopsy (P02)

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

25. MDT Agreement Non Biopsy Cancer Resection (P03)

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

27. MDT Agreement Non Biopsy Other (P04)

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

29. Addendum Reports

30. 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

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

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

33. Histology only % Combined Amended/Corrected Reports 2017 v 2016

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

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

36. Cytology Only Amended/Corrected Reports 2017/2016

37. Turnaround Times

38. Turnaround Times – Small Biopsy
Quarterly

39. Turnaround Times – Small Biopsy
2017 v 2016

40. Turnaround Times - GI Endoscopic Biopsy- 2012-2017 Quarterly

41. Turnaround Time GI Endoscopic Biopsy. Funnel Plot

42. Turnaround Times - GI Endoscopic Biopsy

43. Turnaround Times - Non Biopsy Cancer Resection (P03)

44. Turnaround Times – Non Biopsy Cancer Resection
2017 v 2016

45. Turnaround Times – Non Biopsy Other
Quarterly

46. Turnaround Times – Non Biopsy Other
2017 v 2016

47. Turnaround Times – Non Gynaecological Cytology FNA
Quarterly

48. Turnaround Times – Non Gynaecological Cytology FNA
2017 v 2016

49. Turnaround Times – Non Gynaecological Cytology Exfoliative
Quarterly

50. Turnaround Times - Non Gynaecological Cytology Exfoliative

51. 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.

52. Frozen Section Correlation and Turnaround Time

53. Frozen Section Concordance per quarter

54. Frozen Section Concordance.
2017 v 2016 .

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

56. Frozen Section Turnaround Time
Quarterly

57. Frozen Section Turnaround Time
2017 v 2016