Dowie R, Stoykova B, Crawford D, Desai M, Mather J, Morgan K, Shirt M
Health Economics Research Group, Brunel University, Uxbridge, UK.
Cytopathology. 2006 Apr;17(2):65-72. doi: 10.1111/j.1365-2303.2006.00304.x.
Cervical screening programmes in England and Wales were advised by the National Institute for Clinical Excellence in 2003 to adopt liquid-based cytology (LBC) in place of conventional Papanicolaou (Pap) cytology to facilitate laboratory efficiency. Pilot evaluations in England and Scotland monitored daily or weekly workloads of smear readers and concluded that LBC could increase hourly throughput rates. This study, instead, used timing surveys to determine screening rates.
Two National Health Service cytology laboratories in Manchester and Stockport were partially converted to the LBC ThinPrep process for a cervical screening trial. Three 1-week timing surveys were conducted over 7 months. The surveys covered all LBC-trained staff. The first survey in Manchester also covered staff undertaking conventional Pap screening. The smear readers used timers to record time taken for examining and reporting each slide.
In Manchester, in the first survey, nearly 1 minute per slide was saved by the LBC method during primary microscopy. In both laboratories, the mean microscopy time for primary screening of LBC slides was reduced by almost 1 minute between the first and second surveys. There was no difference between the second and third surveys. Microscopy by cytopathologists was also 1 minute per slide quicker with LBC than conventional Pap. The LBC inadequate rates for both laboratories were <2.0%. Organizational factors impacted on the hourly LBC primary screening rates in the laboratories, the rate for Stockport being higher than the rates in the pilot evaluations.
The timing surveys confirm that the LBC ThinPrep technology can improve laboratory efficiency. However, decision-makers should also consider the overall costs and benefits of introducing the technology in screening programmes, including the capital investment and workforce implications.
2003年，英国国家临床优化研究所建议英格兰和威尔士的宫颈筛查项目采用液基细胞学检查（LBC）取代传统的巴氏细胞学检查，以提高实验室效率。英格兰和苏格兰的试点评估监测了涂片阅片者的每日或每周工作量，并得出结论，LBC可提高每小时的通过率。本研究则采用计时调查来确定筛查率。
曼彻斯特和斯托克波特的两家国民保健服务细胞学实验室部分转换为LBC ThinPrep流程以进行宫颈筛查试验。在7个月内进行了三次为期1周的计时调查。调查涵盖了所有接受过LBC培训的工作人员。曼彻斯特的第一次调查还涵盖了进行传统巴氏筛查的工作人员。涂片阅片者使用计时器记录检查和报告每张玻片所需的时间。
在曼彻斯特，第一次调查中，LBC方法在初次显微镜检查期间每张玻片节省了近1分钟。在两个实验室中，第一次和第二次调查之间，LBC玻片初次筛查的平均显微镜检查时间减少了近1分钟。第二次和第三次调查之间没有差异。细胞病理学家对LBC的显微镜检查每张玻片也比传统巴氏检查快1分钟。两个实验室的LBC不合格率均<2.0%。组织因素影响了实验室每小时的LBC初次筛查率，斯托克波特的比率高于试点评估中的比率。
计时调查证实，LBC ThinPrep技术可提高实验室效率。然而，决策者还应考虑在筛查项目中引入该技术的总体成本和收益，包括资本投资和对劳动力的影响。
