Amended Report Research Articles

AMA Wrestles With Future–Medicare’s and Its Own

AMA Wrestles With Future–Medicare’s and Its Own

APA Makes Presence Felt At Recent AMA Meeting

APA Makes Presence Felt At Recent AMA Meeting

Detection of false-negative papanicolaou smears by rapid rescreening in a large routine cervical cytology laboratory

Rapid rescreening was established in our laboratory in 1995, following the publication of several studies indicating improved sensitivity for the detection of abnormalities in cervical smears. During the study period, 285,841 negative smears (representing 89.09% of the total workload) were rapidly rescreened. A total of 7,650 (2.68%) were identified as abnormal or suspicious and selected for full rescreening. Of these, 228 cases were considered abnormal following pathologist review and resulted in the issue of an amended report. This represents an increased detection rate for all abnormalities of 0.08%. Of the cases with histological follow-up, a high grade epithelial abnormality (HGEA) was confirmed in 31% of cases and a low grade epithelial abnormality (LGEA) in 42%. We conclude that rapid rescreening is easily incorporated into the daily workflow of a large routine cervical cytology laboratory, Our results support conclusions from previous studies that rapid rescreening is an effective quality control technique resulting in the detection of increased numbers of abnormal smears.

Another quality assurance issue--amended reports: what do we really know about them?

The Clinical Laboratory Improvement Amendment (CLIA) of 1988 requires that if a cytology/histology discrepancy is discovered which is significant and affects patient care, an amended report should be issued (Clinical Laboratory Improvement Amendments, Fed Reg 1992;57:7169). Since little is known about such amended reports, a survey was developed to assess how individuals handle discrepancies. The Quality Assurance Task Force from the Papanicolaou Society of Cytopathology created a survey to assess these methods and sent it to all of their members. Fifty-one individuals responded to the survey. Methods vary widely among institutions. On average, 107 cytologic/histologic correlations are performed each month with the discovery of approximately 2 major and 11 minor discrepancies. Thirty-nine responders utilize written amended reports and telephone clinicians when a major discrepancy is found. Thirty-eight individuals indicated that their place of employment has a written policy concerning discrepancies. Time spent in quality assurance issues averaged 8 hr per wk for cytotechnologists and 3 hr per wk for pathologists. Although amended reports are required when significant discrepancies are revealed, a standard practice does not exist.

Training for Management

SINCE the Urwick Committee was appointed in October 1945, “To advise the Minister of Education on educational facilities required for management in industry and commerce, with particular reference to the steps to be taken in regard to the organisation of studies, bearing in mind the various requirements of professional organisations and the need for their co-ordination”, the importance of efficient management has been repeatedly stressed in relation to the productive effort of Great Britain, and the Government has already accepted the recommendation of the Baillieu Committee for the establishment of a British Institute of Management. The eighth International Conference on Management, at which Great Britain was represented, has recently been held in Stockholm. The Urwick Committee reported in August 1946, but after a meeting with representatives of the professional bodies concerned with the part-time study of management in technical and commercial colleges, certain amendments to the report were made by the Committee. The amended report now published* is not only approved by the Minister of Education, but also the institutions and associations represented at the meeting have agreed to do all in their power to implement its recommendations.