Interdisciplinary quality improvement in oculoplastic surgery: transforming biopsy follow-up through PDSA cycles

Abstract

Objective

To evaluate and improve the quality of periocular biopsy follow-up by determining the absolute compliance rate, examining delays between stages, identifying obstacles to high-quality follow-up, and offering recommendations for improvement.

Methods

Phase 1: A retrospective, observational, and descriptive study was conducted using chart reviews of adult patients who underwent periocular biopsies at the Centre Hospitalier Universitaire de Sherbrooke (CHUS) from January 2019 to October 2022. Phase 2: Three simultaneous Plan-Do-Study-Act (PDSA) cycles were implemented, focusing on enhancing communication channels between clinicians and pathologists, introducing a priority system for urgent cases, and establishing an automatic reminder system for pathologists.

Results

Phase 1: Among the 103 patients analyzed, 29 had malignant lesions, while 74 had nonmalignant lesions. The absolute compliance rate was 37.9% for malignant lesions. All of these noncompliances were due to excessive turnaround time (TT) to issue the pathology report. The percentage of cases that had adequate pathology TT (≤ 7 days) were 37.9% for malignant lesions, much lower than the Quebec Ministry of Health's target (80% at ≤7 days). Phase 2: The implemented PDSA cycles led to significant increases in absolute compliance rates and pathology TT compliance rates for malignant lesions. Primary outcomes showed that the absolute compliance rate increased to 93.3%. Secondary outcomes indicated that the pathology TT compliance rate also reached 93.3%.

Conclusions

Delayed pathology reporting was identified as the primary cause of suboptimal follow-up. The successful implementation of targeted PDSA cycles improved communication, prioritization, and reminder systems, resulting in considerable improvements in primary and secondary outcomes.