Purpose: Decrease turn-around time (TAT) and increase customer satisfaction.
Relevant Background: Cytologic screening (PAP test) lowered mortality of cervical carcinoma. As high-risk papilloma viruses (HPV) were associated with dysplasia and carcinoma, “co-testing” (HPV status and cytological screening on same specimen)was introduced. Women with negative Pap smear and positive high-risk HPV are at elevated risk.
Previous Status: Pap smears were signed-out; HPV Cotests were sent to reference laboratory; results were informed in supplementary report. This caused slow TAT for HPV Co-test (24% > 12 days) and distress when negative Pap smear was followed by a positive HPV Co-test.
Methods: A team of relevant individuals was convened to decrease TAT for HPV Co-test to 6 days, and to create an integrated Pap-smear/HPV Co-test report. The decision was made to bring HPV testing in-house, utilizing polymerase chain reaction-based assay. The technique was validated; precision, accuracy and lower levels of detection were determined. Standard Operating Procedures were written, and personnel competency was verified. Proficiency tests were performed. Staff met to coordinate logistics of sample transfer.
Data Analysis: In-house HPV testing twice weekly decreased TAT from 10.1 to 5.6 days. Integrated report: HPV test is performed when ordered by clinician or “reflex” if Pap smear is atypical; in both instances, final report is withheld until Co-test result is available. HPV is run inhouse in batches twice a week (5-hour test TAT). When HPV result is available, cytology technician enters Pap smear interpretation and HPV Co-test in a single, integrated report into VistA, it is released by the pathologist or cytotechnologist (day 3-5) and “view-alert” is issued for provider in CPRS. Integrated report consists of a section with cytology findings, and section with HPV status including subtype and risk information.
Results: Average TAT for release of integrated report decreased from 10.1 to 2.7 days. The laboratory achieved a 35% reduction in expenditure costs. Clinicians’ response was uniformly positive.
Implications: It is important to know how VA Medical Centers address PAP-HPV Co-test, and how the system can be modified; particularly, as our female Veteran population increases.
