The Pathology Clinical Indicator set has had some major changes in this revision of the set. There are now 24 indicators organised into six speciality areas (Chemical Pathology, Haematology, Anatomical Pathology, Microbiology, Point of Care Testing, and Whole of Service).
New stratifications have been added for services, as the previous Australian Institute of Health and Welfare public hospital peer groups were not leaning towards a meaningful comparison of peers. So the peer grouping now is based on either the situation of on-site pathology versus off-site pathology services.
In the area of Chemical Pathology, the indicators were retained but the serum/plasma potassium and troponin turnaround time from the emergency department to measure the collection to arrival in the laboratory time and the in-lab to validated result time were updated to allow for better time durations to be met. These indicators had previously been particularly hard to meet for some services, where pathology was located off-site or in a separate building on a large hospital campus. They should be easier to meet now. This has also occurred in the Haematology area with blood groups and haemoglobin results to the emergency department being measured for collection separately to testing.
Anatomical Pathology times have been revised to ‘received to validated’ to reflect working days, rather than calendar days. Microbiology had significant changes with a new indicator (4.1) to measure blood culture testing. It is acknowledged that this indicator will be more likely to be used by larger centralised laboratories than smaller ones as it relies on automated blood culture technology, but it is expected that this technology will filter down to smaller laboratories over the next four years of the update cycle. COVID-19 testing turnaround was also added to this section with indicator 4.3.
Point of Care Testing was added as a clinical area as this is an emerging technology and a growing area of patient care, especially in rural areas or areas which typically had a lower level of laboratory service. The two indicators in this area, both yes/no questions, are designed to determine implementation of the basics of Point of Care testing with a view that as this clinical area develops, the indicators here will change to numerator/denominator-based indicators.
The Whole of Service area has been expanded to measure errors prior to receipt, and post receipt to identify specimen handling or patient identification errors. Haemolysis measurement is for potassium specimens and has been added as this measures an area of great risk when having to recollect on a test which requires a short testing period. A standardised chart for measurement of haemolysis has been added to the appendix.
The large number of updates for Pathology ensure that the set is well prepared for the future and went through multiple RCPA Quality Committee and sub-committee reviews. This will assist in delivering quality results in terms of measurement expectations and person-centred care into the future.