Telecytology rapid on-site evaluation: Diagnostic challenges, technical issues and lessons learned

Area of Science:

• Cytopathology
• Medical Informatics
• Quality Improvement

Background:

• Rapid on-site evaluation (ROSE) enhances diagnostic adequacy and specimen triage.
• Telecytology ROSE offers a viable alternative to traditional ROSE, demonstrating high concordance.
• However, telecytology introduces potential for new errors due to its complex system and personnel involvement.

Purpose of the Study:

• To identify and categorize errors encountered during telecytology ROSE implementation.
• To analyze the types, causes, and frequency of telecytology ROSE errors.
• To provide lessons learned and recommendations for mitigating these errors.

Main Methods:

• A retrospective review of telecytology ROSE errors was conducted from 2017 to 2019.
• Errors were classified as technical, cytotechnologist-related, or pathologist-related.
• Data collected included error type, cause, diagnoses, and corrective actions.

Main Results:

• 46 (1.3%) telecytology ROSE sessions had documented errors.
• Pathologist interpretation errors were most common (50%), followed by cytotechnologist errors (28%) and technical errors (22%).
• Most technical and cytotechnologist errors occurred within the first year; common interpretation errors involved microorganisms and tumor classification.

Conclusions:

• Telecytology ROSE is susceptible to various errors, including technical, human, and interpretation-related issues.
• Familiarity with the system, staff training, and prompt feedback are crucial for error reduction.
• Implementing a robust quality improvement program with error documentation and action is recommended.