RCPA Internal Quality Assurance (IQA) Frameworks all Disciplines

Presenters Peter Stewart Mary Jo Waters Microbiology Katherine Nicholls - Immunopathology Kym Mina Genetic Pathology Neil Langlois Forensic Pathology Bronwen Ross Management and/or Academic Pathology Merrole Cole-Sinclair Haematology Peter Stewart Chemical Pathology

Overview Revalidation the driver Australian scenario International trends RCPA Probable revalidation structure RCPA - CPDP IQA Frameworks all disciplines RCPA Website Discussion

What is Revalidation? A process by which doctors show they are up to date and fit to practice and provide appropriate level of care that is evidenced based

Revalidation in Australia Interim Report on Revalidation now released for comment Mid 2017- Implementation Future - aspire to evidence based / relevant/multifaceted/valid/cost efficient framework to ensure standards meet professional and community expectations Our College - Positioning for future

Revalidation RCPA

International Developments-UK A National Revalidation Process - all licenced doctors MUST demonstrate every 5 years they are up to date and fit to practice Through connection with one organisation eg (RCPath)

International Developments-UK Responsible Officer of Designated Body will make a recommendation on an individuals revalidation. GMC makes final decision Supporting information would include: - yearly appraisal CPD Quality activities Reflective learning Feedback from colleagues and patients review of complaints and compliments

International Developments-UK Undergoing 5 year review Pushback from profession

International Developments-Canada Mandatory CPD Physician Achievement Review (multisource feedback) Peer Assessment (random and targeted)

International Developments - USA Voluntary certification but 85% board certify Recertification every 5-10 years for maintenance of recertification MOC contains 4 elements Evidence of professional standing Participation in knowledge self-assessment Examination Practice audit and improvement

International Developments - NZ CPD Regular Practice Review(RPR) Multisource assessment includes: peer assessment identify learning needs personal development plan

Summary of Trends Adoption of compulsory revalidation Strengthening of existing programs Uniform national legislation Australia is a laggard

Revalidation RCPA Aim is to assess competency Based on CPD framework Focus on standard practice Capacity to identify outliers Identify opportunity for improvement and corrective action

Pathology Competency Assessment Tool Box 1. CPDP 2. Workplace Performance Review 3. IQA Documentation - Specialties to develop own portfolio 4. EQA - Individual participation

RCPA - CPDP Relevant to scope of practice RCPA only (clinical separate) Cat A - Group Activity - 20 hours pa Cat B - Personal Study - 20 hours pa Cat C - Quality Activity -10 hours pa 2016/2017 IQA additional 10 hours pa

RCPA - CPDP As at 01 January 2016 the RCPA mandated 10 hours peer review (Section 1 of IQA Framework) in addition to 10 hours from Category C CPDP requirements for Anatomical Pathology (20 hours) From 01 January 2017 remaining disciplines will be required to participate in a minimum of 10 hours per annum of peer review activities (Section 1 of your IQA Framework) in addition to 10 hours from Category C of the CPDP

Definition Internal Quality Assurance Internal Quality Assurance (IQA) = peer review/ clinical /technical audit activities Westgard JO and Westgard S (editors) Clinics in Laboratory Medicine 2013; 1:1-206 (March). Quality Control in the Age of Risk Management. Clinical Pathology Accreditation (UK) Ltd, 2004 Mifsud A and Shafi MS. Clin Pathol 1995;48:560-563.

RCPA IQA Frameworks The RCPA IQA Framework Activities: Contain activities that aim to help monitor performance, drive improvement and support collaborative on-going professional practice. Aim to improve the quality of patient management and/or outcomes Activities focus on peer-review (Section 1) and Technical audit (Section 2) Requires documented evidence of a pathologist s involvement in internal quality activities. Practice based- developed in consultation with discipline advisory committees Most pathologists are already doing these activities but not necessarily recording them

RCPA IQA Frameworks Microbiology Framework Presented by Mary Jo Waters

Microbiology Framework Diagnostic measures Positive blood culture review Infection control steering committee Outbreak review- multidisciplinary Amended reports- list-categorise- determine potential individual training issues Technical measures Non conformance reporting Incorrect specimen type- review test manual and compliance with instructions Specimen contamination- sources, cause, remedial action Audit of service provision Critical results notification- audit against existing laboratory protocols Non-sample QAP program- serology reporting Part of daily activity - consider ease of documentation.

RCPA IQA Frameworks Immunopathology Framework Presented by Katherine Nicholls

Immunopathology Framework Standard interaction with lab scientists with difficult cases is a valid IQA activity Interaction with ordering clinicians over difficult case (misleading lab results) is a valid IQA activity For those with non lab based jobs, the RCPA QAP case series will be expanded

RCPA IQA Frameworks Genetic Pathology Framework Presented by Kym Mina

Genetic Pathology Framework Deliberately limited detail, reflecting the highly varied and evolving role of the Genetic Pathologist Genetic Pathologists are encouraged to use ideas from other discipline frameworks or their own ideas Second opinions would include second opinions for/from other Genetic Pathologists second opinions for non-pathologists (results returned from testing performed in another laboratory/overseas) active participation in meetings/discussions on classification of specific variants or abnormal findings Compliance with published guidelines NATA/NPAAC guidelines disease-specific recommendations (for example from EMQN) internationally adopted variant classification (eg ACMG 2015) EQA participation can be used but only if individual participation

RCPA IQA Frameworks Forensic Pathology Framework Presented by Neil Langlois

Forensic Pathology Framework Peer review options: Between pathologists one reviewing another s report reviewing pathologist credited with time spent reviewing report both pathologists credited with time discussing review Performed by a group, which may include non-pathologists (eg: Coroners) all pathologists credited with review time Must be auditable: Record date, who present, time spent on review, case numbers Nature of discussion and outcome not essential to record

RCPA IQA Frameworks Management and/or Academic Pathology Framework Presented by Bronwen Ross

RCPA IQA Frameworks Haematology Framework Presented by Merrole Cole-Sinclair

Haematology Framework RCPA CPDP compulsory from 2016 for dual trained fellows RCPA IQA compulsory from 2017 Likely already performing IQA in current practice will now need to document time spent. Suggested activities: Group case reviews e.g. weekly morphology meeting - all attendees can record time spent reviewing cases as peer review activity Informal and formal second opinions - time spent reviewing case can be recorded by second haematologist; time spent discussing case and considering any concordance or discordance after second haematologist has reviewed it could be recorded by both. Discussion/interpretation/advice about laboratory investigations with other haematologists/oncologists/geneticists

Haematology Framework Pathologist: WN INTERNAL CONSULTATIONS ON PATHOLOGY CASES [if LIS cannot record] Month: Jan / Feb / Mar/ Apr / May / Jun / July / Aug / Sept / Oct / Nov / Dec (Please circle the month) Date Pathology Accession Consultation at request of Outcome 1=Agree 2= Specials 3=Disagree If not agreed indicate action Time taken in minutes 10/11 S15 16772 PB 1 5 12/11 C15 18771 NZ 2 2 15/11 S13 1321/S15 AD 1 10 17781 22/11 S15 17821 PB 3 3 TOTAL MINUTES FOR MONTH = 20

Haematology Framework FORMAL CASE REVIEW AND ACTION SHEET [EXAMPLE A] Accession: S15-15726 Nature of specimen: Diagnosis: Initial reporting pathologist: AD Reviewing pathologist: WR Date of review: 15/11/15 Description of Review Process: Time involved in review: 5 mins Result:X Concordant Minor /non clinical (typo/ spelling mistake etc) Minor / clinical Major Minor disagreement/discordance - represent where there is a small change in diagnosis but there is minimal or no clinical impact. Major disagreement/ discordance - represent a significant difference between original diagnosis and the final diagnosis where potentially there is a significant impact on a patient s treatment or outcome. Details of any discordance: N/A Record any disagreement which may arise between the original diagnostic report and the review. Issue an addendum if required and follow up according to your individual laboratory policy for such incidents. Action: X None As per Laboratory Protocol Pathologist signatures:

RCPA IQA Frameworks Chemical Pathology Framework Presented by Peter Stewart

Chemical Pathology Framework Internal Case Reviews (peer process) External Case Reviews/Compliance with Position Statements QAP comment Program Cross Discipline meetings-icu/ Emerg/Clinics NATA/RCPA assessments Technical Peer review of TATs/Report format etc.

Chemical Pathology Framework IQA is challenging for the small specialities Diagnostic measures are mandatory. Technical measures are optional May require new group activities Tools may be used for other purposes A process in evolution

RCPA Website http://www.rcpa.edu.au/fellows/practising-pathology

RCPA Website

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