5979例外科病理报告的及时性分析

Timeliness of 5979 surgical pathology reports

目的 调查解放军总医院病理科病理报告的及时性情况 ,分析影响其及时性的原因 ,为病理工作持续的质量改进提供科学的依据。方法 采用整群抽样的原则 ,从 2 0 0 0年 4个季度中各抽取 1个月的所有外科病理检查标本共 5 979例 ,其中小活检标本 5 2 5 0例 ,手术标本 72 9例 ,分别统计两种标本病理报告的周转时间 ,并分析延迟病理报告的常见原因。结果 5 2 5 0例活检标本中 ,72h内发出病理报告者为 4872例 ,占 92 8% ;72 9例手术大标本中 ,96h内发出病理报告者为 613例 ,占84 1%。小活检标本延迟病理报告的常见原因为 :需进一步做免疫组织化学染色 ,术中进行过冷冻切片诊断而标本却延迟一天送到病理科。需要重新取材或深切 ,疑难病例需全科专家传阅会诊 ,骨科病例未提供影像学资料或需脱钙 ,以及未提供详细病史等。手术大标本延迟病理报告的常见原因与上述基本相同 ,而最终病理诊断依赖进一步电镜检查者很少 ,只占所有标本的 1 4%。入病理科前和病理科内因素在小活检标本各为 3 3 6% ( 12 7例 )和 66 4% ( 2 5 1例 ) ,而在手术大标本各为 5 0 9% ( 5 9例 )和 49 1% ( 5 7例 )。结论 该病理科 90 %左右的病理报告可以及时发出 ,超过国际标准。病理报告延迟的原因有科内、外两类 。

Objective To analyze the influence of prelaboratory and intralaboratory factors on the turnaround time of the reports in order to develop a reference database for continuous quality improvement, a retrospective study of the timeliness was reported. Methods Using cluster sampling of a total of 5 979 pathology reports selected by sampling a single month′s reports from each quarter of the year 2000, of which there were 5 250 cases from routine biopsy and 729 cases from operative specimen. The timeliness and the factors that influence the turnaround time of the two types of surgical pathology reports were analyzed. Results 4 872 pathology reports of 5 250 routine biopsy cases were completed in 3 working days, and 613 of 729 cases of the operative specimens were completed in 4 working days. The percentage was 92.8% and 84.1% respectively. Factors that significantly contributed to the increase in turnover time of biopsy reports included request of immunohistochemical staining, delayed arrival of the operative specimen at the laboratory after frozen section, additional recutting, intradepartment consultation and decalcification etc. As for the operative cases, several factors were associated with delayed report: second day arrival of the operative specimen at the laboratory after frozen section, lack of the adequate clinical history, request for immunohistochemical staining etc. Conclusions The majority of surgical pathology reports in the department can be completed timely and the timeliness meets the general standard. Only about 10 percents of the reports were delayed because of some prelaboratory and intralaboratory factors, for which there were 33.5% and 66.5% respectively for routine biopsy, and 50.9% and 49.1% respectively for operative specimen.