Effectiveness of Toyota Process Redesign in Reducing Thyroid Gland Fine-Needle Aspiration Error

  1. Stephen S. Raab, MD1,
  2. Dana Marie Grzybicki, MD, PhD1,
  3. Daniel Sudilovsky, MD1,
  4. Ronald Balassanian, MD1,
  5. Janine E. Janosky, PhD2, and
  6. Colleen M. Vrbin1
  1. 1From the Departments of Pathology and
  2. 2Family Medicine and Epidemiology, University of Pittsburgh School of Medicine, Pittsburgh, PA

Abstract

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.

Footnotes

  • Supported by grant HS13321-01 from the Agency for Healthcare Research and Quality, Bethesda, MD, and a grant from the Jewish Healthcare Foundation, Pittsburgh, PA.

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