Improving Papanicolaou test quality and reducing medical errors by using Toyota production system methods.
OBJECTIVE
The objective of the study was to determine whether the Toyota production system process improves Papanicolaou test quality and patient safety.


METHODS
An 8-month nonconcurrent cohort study that included 464 case and 639 control women who had a Papanicolaou test was performed. Office workflow was redesigned using Toyota production system methods by introducing a 1-by-1 continuous flow process. We measured the frequency of Papanicolaou tests without a transformation zone component, follow-up and Bethesda System diagnostic frequency of atypical squamous cells of undetermined significance, and diagnostic error frequency.


RESULTS
After the intervention, the percentage of Papanicolaou tests lacking a transformation zone component decreased from 9.9% to 4.7% (P = .001). The percentage of Papanicolaou tests with a diagnosis of atypical squamous cells of undetermined significance decreased from 7.8% to 3.9% (P = .007). The frequency of error per correlating cytologic-histologic specimen pair decreased from 9.52% to 7.84%.


CONCLUSIONS
The introduction of the Toyota production system process resulted in improved Papanicolaou test quality.
Raab
Stephen S
SS
Department of Pathology, School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA 15232, USA. raabss@upmc.edu
Andrew-Jaja
Carey
C
Condel
Jennifer L
JL
Dabbs
David J
DJ
D016022:Case-Control Studies; D015331:Cohort Studies; D003951:Diagnostic Errors / Q000517:prevention & control* / Q000706:statistics & numerical data; D017598:Efficiency, Organizational; D005260:Female; D006801:Humans; D065006:Papanicolaou Test; D017064:Process Assessment, Health Care; D011785:Quality Assurance, Health Care; D013997:Time Factors; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis*; D014626:Vaginal Smears / Q000592:standards*