Unsatisfactory ThinPrep Pap Tests: An Educational Approach to Quality
Kelly Olson1, Erek Kucher2, Ashley Rasmussen2
1Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
Background:
The unsatisfactory percentage for ThinPrep Pap Tests (TPPT) at our institution reached the 75th percentile (2.7%) benchmark established by the College of American Pathologists (CAP). Our aim was to identify outliers by analysis of data, provide education and feedback, and establish a system to monitor outcomes.
Methods:
The laboratory information system (LIS) was queried for TPPT cases diagnosed as 'Non-diagnostic' between April and June 2022. Two hundred and thirty-two cases were identified and reviewed by 2 cytopathologists and 1 cytotechnologist to identify limiting factors, including cellularity, blood, lubricant, inflammation, and mucus. The percentage of unsatisfactory TPPT was evaluated for both clinicians and clinics and stratified into peer groups based on total TPPT collected. The two clinics with the highest unsatisfactory percentage in a peer group of > 500 TPPT collected were identified. A LIS report was created to improve efficiency in future data collection.
Results:
Low cellularity was a limiting factor in 100% of cases, blood in 51.7% (n = 120), lubricant in 18.5% (n = 43), inflammation in 13.8% (n = 32), and mucus in 3.9% (n = 9), with multiple factors possible per case. Twenty clinics collected > 500 TPPT for FY2022. Two clinics (1 resident-led clinic) had an unsatisfactory percentage > 3%, for which to target interventions. Clinic 1 had an unsatisfactory percentage of 6.1% (62/1018), and clinic 2 was 3.5% (21/608).
Conclusions:
To address limiting factors, a laboratory bulletin with best practices for TPPT collection and a list of Hologic TPPT approved lubricants was sent to each clinic. Statistics of unsatisfactory TPPT were provided. The highest unsatisfactory TPPT clinics received Hologic educational materials and an educational session. The resolution of laboratory quality issues requires investigations, often laborious in nature. In an era of staffing shortages, an effective LIS is essential to efficiently investigate and resolve quality variances. TPPT data via LIS reports were reviewed at 3 months and 1-year post-intervention implementation to evaluate outcomes.
