Improving laboratory criteria to reduce unnecessary peripheral blood smear reviews by pathologists.

Abstract

Introduction: Pathologists frequently perform reviews of peripheral blood smears with limited clinical impact. There is considerable heterogeneity, however, in the laboratory criteria different institutions use to trigger these pathologist blood smear reviews (PBSRs).

Methods: We retrospectively reviewed 1782 laboratory-initiated PBSRs performed at our institution to understand the indications for PBSR and their outcomes. Based on our findings, we revised our laboratory's PBSR criteria as part of a quality improvement initiative to reduce the number of unnecessary reviews. All PBSRs were tracked for several months before and after the intervention to assess the impact of our intervention.

Results: At baseline, 89% of PBSRs yielded no additional information, and only 6% yielded new information that appeared to be clinically impactful. The PBSR criteria based on abnormal platelet counts or leukopenia contributed to a disproportionate number of noncontributory reviews. Removing these conditions from our criteria led to an increase in the proportion of PBSRs yielding novel information from 7% to 16% and reduced the total number of reviews performed monthly by 17%.

Discussion: Removal of low-yield conditions from our laboratory's PBSR criteria led to a reduction in the number of unnecessary reviews performed. Our work demonstrates a practical quality improvement strategy to improve PBSR utility without compromising patient care.