Cost containment, quality assurance, and physician microscopy of cerebrospinal fluid with normal cell counts. Analysis of 1,677 consecutive specimens.
During a six-month interval, 1,677 cerebrospinal fluid (CSF) specimens with cell counts of 0 to 5 X 10(6)/L were examined by one of six physician microscopists. Malignant cells were found in ten of these CSF specimens. In seven, unidentified cells had been noted on prior review by a technologist. Technologists had a frequency of false negative errors of 0.12%. Physicians had a frequency of apparent false positive errors of 0.12%. There is little or no benefit from physician microscopic examination of all CSF specimens that have normal cell counts. Adoption of a different policy would reduce medical care costs by $40,000 for this entire series of 1,677 specimens without adversely affecting the quality of laboratory results.
Fairbanks
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VF
Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota 55905.
Folger
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WN
D000293:Adolescent; D000368:Aged; D000369:Aged, 80 and over; D001826:Body Fluids / Q000166:cytology; D002452:Cell Count; D002555:Cerebrospinal Fluid / Q000166:cytology*; D002648:Child; D003363:Cost Control; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D013677:Medical Laboratory Science; D008875:Middle Aged; D010338:Pathology, Clinical; D011785:Quality Assurance, Health Care / Q000191:economics*