Raab Stephen S, Grzybicki Dana Marie, Sudilovsky Daniel, Balassanian Ronald, Janosky Janine E, Vrbin Colleen M
Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15232, USA.
Am J Clin Pathol. 2006 Oct;126(4):585-92. doi: 10.1309/NJQ1L7KA10UKV93Q.
Our objective was to determine whether the Toyota Production System process redesign resulted in diagnostic error reduction for patients who underwent cytologic evaluation of thyroid nodules. In this longitudinal, nonconcurrent cohort study, we compared the diagnostic error frequency of a thyroid aspiration service before and after implementation of error reduction initiatives consisting of adoption of a standardized diagnostic terminology scheme and an immediate interpretation service. A total of 2,424 patients underwent aspiration. Following terminology standardization, the false-negative rate decreased from 41.8% to 19.1% (P = .006), the specimen nondiagnostic rate increased from 5.8% to 19.8% (P < .001), and the sensitivity increased from 70.2% to 90.6% (P < .001). Cases with an immediate interpretation had a lower noninterpretable specimen rate than those without immediate interpretation (P < .001). Toyota process change led to significantly fewer diagnostic errors for patients who underwent thyroid fine-needle aspiration.
我们的目标是确定丰田生产系统流程重新设计是否能减少接受甲状腺结节细胞学评估患者的诊断错误。在这项纵向、非同期队列研究中，我们比较了在实施包括采用标准化诊断术语方案和即时解读服务在内的减少错误措施前后，甲状腺穿刺服务的诊断错误频率。共有2424例患者接受了穿刺。术语标准化后，假阴性率从41.8%降至19.1%（P = .006），标本无法诊断率从5.8%升至19.8%（P < .001），灵敏度从70.2%升至90.6%（P < .001）。有即时解读的病例不可解读标本率低于无即时解读的病例（P < .001）。丰田流程变革使接受甲状腺细针穿刺的患者诊断错误显著减少。
