1. NCN Prostate Core Biopsy Reporting Audit Dr Ursula Earl NCN Histopath SSG Audit Lead

2. Methodology Lab managers asked to complete a datasheet 4 questions One side of A4

3. Lab Managers’ Data Sheet Number of cases received between Oct 1 st to Dec 31 st 2013 Histological diagnosis by % type using specific (RCPath) SNOMED code search Turnaround time from date of biopsy taken to date of report authorisation % of cases with immunohistochemistry

4. Standards – Final diagnosis % of cases in four diagnostic categories (malignant, benign, high grade PIN, suspicious) Re-audit of TRUS prostate biopsy reporting in West Kent comparing data from two trusts with Ontario 2010 data ( Bulletin of RCPath April 2012, 158, 95-100 )

5. Standards – Turnaround Times RCPath KPI 6.4 – 80% of cases reported within 7 calendar days, 90% of cases reported within 10 calendar days of biopsy/procedure NHS Improvement: Learning how to achieve a seven day turnaround time in histopathology

6. Number of cases received NCN Trust Range 93-200 Kent – figures supplied for a 10 month period March – Dec 2010 for Trust A, Trust B & Trusts A & B combined) Kent A - 136.5 in 3 month period Kent B - 43.8 in 3 month period Kent A&B - 233 in 3 month period

8. Histological diagnosis – SNOMED codes Adenocarcinoma (M81403) High grade PIN (M81402) Suspicious (M69760, M69700) Benign (M09450, M09460, M40000, M72000 etc)

9. % of cases by diagnostic category

10. Adenocarcinoma Diagnosis NCN Range -40 – 62% Kent combined -52.2% Kent A – 55.6% Kent B – 47.2% Ontario – 47%

11. Kent A Ontario

12. % of cases high grade PIN or suspicious

13. Benign Diagnosis NCN range - 34.5 – 47.3% Kent A – 36.7% Kent B - 45.6% Kent com -40.3% Ontario – 40%

14. % of cases with benign diagnosis Kent A

15. Use of IHC NCN range -27% to 82% Kent comb -30% Kent A –33% Kent B - 25%

16. % of cases with IHC

17. Turnaround Time KPI 6.4 90% of cases reported within 10 calendar days 80% of cases reported within 7 calendar days NHS IMPROVEMENT 7 day reporting TAT

18. TAT - Methodology Some trusts struggled to provide this data because of limitations of their lab computer systems & separation of prostatic core biopsy samples from other prostate specimens

20. Achieving a 7 day TAT

21. Achieving a 90% 10 day TAT

23. Summary - TAT All trusts meeting the RCPath KPI 6.4 standard of 80% of cases reported within 7 calendar days 6 of 7 trusts meeting the RCPath KPI 6.4 standard of 90% of cases reported within 10 calendar days No trust met NHS Improvement target of 100%, 7 day turnaround

24. Questions? Variable use of IHC between trusts Use of suspicious as a diagnostic category Data recording & retrieval on lab computer systems, is Pathosys fullfilling all the audit functions?

25. Action Plan Present findings at NCN Histopath Audit meeting at Evolve, June 10 th 2014 Send presentation to participating pathologists & lab managers. Individual departments to review their figures & compare with other trusts Root cause analysis if significant discrepancies flagged

26. Acknowledgements & Thanks Peter Booth, Trudy Johnson, Derek Pace Jacqui Richards, Sharron Williams, IanTaylor,, Phil Gibson, Adrienne Mutton, Paul Barrett, Muhammad Siddiqui, Matthew Theodosiou, Diane Hemming, Bob Stirling, Amira El Sharif, Sri Nagarajan