影响病理报告及时性的多因素分析

Multiple factor analysis on timeliness of pathology report

目的回顾性调查中南大学湘雅医院病理科病理报告的及时性,分析其影响因素,为改进病理科质量控制工作提供科学依据。方法采用整群抽样原则,从2000～2004年5年中,各随机抽取1个月的病理样本共10275例,其中活检标本4672例,手术标本5603例(其中包含4537例常规手术标本和1066例冰冻切片标本)。分别统计3类标本从接收到签发报告的时间,并分析延迟报告的常见原因。结果4672例活检标本中,72h以内发报告者4354例,占93.32%;318例延迟报告,占6.78%。4537例手术标本中,96h内发出报告者4267例,占94.04%,270例延迟报告,占5.96%。活检标本延迟报告的科内和科外因素分别为80.53(%256例)和19.52(%62例),手术大标本分别为76.67(%207例)和23.33(%63例)。活检标本与手术标本延迟报告的原因相似,以科内因素为主:包括免疫组化染色,补充取材,疑难病例全科讨论会诊,骨组织脱钙等等。冰冻切片标本30min内发报告率占87.14%,30min后发报告者占9.75%,对术中难以确定良恶性及制片困难等原因,需待常规石蜡切片确诊的病例视为延迟报告,延迟报告者占3.26%,报告时间与送检组织的大小、数量、质地和疑难度等因素有关。结论该科95%的病理报告可按时发出,超过国际标准。病理报告延迟的原因有科内和科外两类,只有在医院领导高度重视和有关科室的共同努力下,才能进一步提高病理诊断质量。

[Objective] To analyze the influence of prelaboratory and intralaboratory factoors on the turnaround time of the pathological reports in order to develop a reference database for continuous quality improvement, a retrospective study of the timeliness was reported. [Methods] A total of 10275 pathologic reports were selected by randomly cluster sampling a single month＇s reports of each year from 2000-2004, of which there were 4 672 cases from routine biopsy and 5603 cases from operative specimen （4 537 cases routine operative specimen and 1 066 cases frozen section specimen）. The timeliness and the factors of influencing the turnaround time of surgical pathology reports were analyzed. [Results] Of 4 672 routine biopsy cases, 4354 cases of pathologic reports were completed in 72 houm, account to 93.32 %, 318 cases were delayed , account to 6.78%. Of 4 537 cases of operative specimens, 4 267 eases were completed in 96 houm, account to 94.04%, 270 cases were delayed, account to 5.96%. The factors significantly contributed to the increase in the turnover time for pathologic reports of biopsy and operative cases ineluding request of immunohistochemical staining, delayed arrival of the operative specimen at the laboratory after frozen section, additional recutting, intradepartment consultation, decalcification of bone and lack of the adequate clinical history etc. In 1 066 frozen section cases, 929 pathology reports were completed in 30 minutes, account to 87.14%. The influence factors of delayed reports contained specimens of the size, quantity and texture, amount and degree of difficulty. [Conclusion] 95% of surgical pathology reports in our department can be completed timely which surpasses the general standard. Only about 6-7 percents of the pathologic reports were delayed because of some intralaboratory and prelaboratory factors.