Jill M. Paulson, MD; Kim Ariyabuddhiphongs, MD; Gila Kriegel, MD; James V. Hennessey, MD
Note: Drs. Paulson and Ariyabuddhiphongs contributed equally to this manuscript.
Acknowledgment: The authors would like to thank Mark Aronson, MD; Carol Bates, MD; Bolanle Bukoye, Edward O'Neill, MD; Jennifer Potter, MD; Joanne Schulze; Scot Sternberg, MS; and Helen Wang, MD, for their assistance with the manuscript.
Potential Conflicts of Interest: Dr. Hennessey: Fees for participation in review activities, such as data monitoring boards, statistical analysis, end point committees, and the like: Novo Nordisk Data Safety Monitoring Board for the Liraglutide (NN2211-1800) Study.
Paulson J., Ariyabuddhiphongs K., Kriegel G., Hennessey J.; Diagnostic Problems After Change in Brand of Lubricant Jelly. Ann Intern Med. 2012;157:678-679. doi: 10.7326/0003-4819-157-9-201211060-00024
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Published: Ann Intern Med. 2012;157(9):678-679.
Background: Quality initiatives will play a vital role in ensuring high-quality clinical outcomes as hospitals move toward cost-saving measures.
Objective: To describe the ramifications and subsequent steps taken after changing the brand of lubricant jelly used at Beth Israel Deaconess Medical Center in Boston, Massachusetts.
Methods and Findings: Our hospital changed the brand of lubricant jelly as a cost-saving measure, and our clinicians subsequently noticed changes in the results of 2 diagnostic procedures.
In our thyroid biopsy clinic, operators use lubricant jelly to facilitate ultrasound conduction, and needles pass through the jelly during fine-needle aspiration procedures. The change in lubricant jelly occurred in December 2009. A few weeks later, endocrinologists noticed an increased frequency of obscuring artifacts in thyroid cytopathology reports. In response, the endocrinology team analyzed 82 ThinPrep (Hologic, Marlborough, Massachussetts) slides from 79 thyroid aspirates. The same endocrinologists collected all of the aspirates. The team examined 24 consecutive aspirates obtained during 6 clinical sessions after the change to the new lubricant jelly (group 1), 28 consecutive aspirates obtained during 5 clinical sessions immediately before the change in lubricant jelly (group 2), and 27 consecutive aspirates obtained during 6 clinical sessions earlier in 2009 when the frequency of nondiagnostic smears was closer to the long-term average (group 3). Analysts deidentified the slides, and 2 cytopathologists independently reviewed them using standard diagnostic criteria (1). When analysts compared slides prepared with the new lubricant (group 1) with those prepared with the old lubricant (groups 2 and 3), there was more artifactual flocculent material and it was more difficult to visualize thyroid follicular cells. For example, 79.2% of the slides in group 1 had grade 1 to 2 flocculence compared with 39.3% in group 2 and 0% in group 3 (P < 0.01). In addition, 54.2% of slides in group 1 were considered nondiagnostic compared with 28.6% in group 2 (P = 0.06) and 22.2% in group 3 (P = 0.02).
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