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Journal of Lower Genital Tract Disease:
doi: 10.1097/LGT.0b013e31815ae9a1
Original Articles

Dissemination of Lean Methods to Improve Pap Testing Quality and Patient Safety

Raab, Stephen S. MD1; Andrew-Jaja, Carey MD2; Grzybicki, Dana M. MD, PhD3; Vrbin, Colleen M. BS1; Chesin, Carole M. MD2; Fisch, John M. MD2; Dabbs, David J. MD1; Sommer, Deborah L. MD2; Blaser, Sandra M. CNM2

Spanish Translation
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Abstract

Objective. To determine if the implementation of Lean methods resulted in improved Pap test quality and diagnostic accuracy in 5 clinician practices.

Materials and Methods. We performed a 1-year case-control study that included 5,384 control (preintervention) and 5,442 case (postintervention) women who had a Pap test procured by 1 of 5 clinicians. Using Lean methods, the clinicians increased their focus of Pap test procurement by creating a "one-by-one" workflow and recorded process completion using a Lean checklist. We compared the case and control Pap test quality and accuracy measures using the proportion of Pap tests lacking a transformation zone component, proportion of unsatisfactory Pap tests, frequency of newly detected cervical intraepithelial neoplasia following a previous benign Pap test, and proportion of Pap tests with a diagnosis of atypical squamous cells of unknown significance.

Results. After the intervention, there was a statistically significant decrease in the mean proportion of Pap tests lacking a transformation zone component, p =.011. Two of 5 clinicians showed a statistically significant decrease in their unsatisfactory Pap test frequency, although the overall Pap test unsatisfactory frequency for the case group was not statistically significant lower, p =.087. The case group showed a 114% increase in newly detected cervical intraepithelial neoplasia following a previous benign Pap test, p =.004. There was no statistically significant difference for the proportion of Pap tests with a diagnosis of atypical squamous cells of unknown significance, p =.908.

Conclusions. Disseminating Lean methods across a group of clinicians resulted in improved Pap test quality and diagnostic accuracy.

©2008The American Society for Colposcopy and Cervical Pathology

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