A CONTINUOUS QUALITY IMPROVEMENT PROJECT TO IMPROVE THE QUALITY OF CERVICAL PAPANICOLAOU SMEARS

Objective: To improve the quality of cervical Papanicolaou smears by c ontinuous quality improvement techniques. Methods: The study used a Pa panicolaou smear data base of over 200,000 specimens collected between June 1988 and December 1992. A team approach employing techniques suc h as process now-charting, cause and effect diagrams, run charts, and a randomized trial of collection methods was used to evaluate potentia l causes of Papanicolaou smear reports with the notation ''inadequate' ' or ''less than optimal'' due to too few or absent endocervical cells . Once a key process variable (method of collection) was identified, t he proportion of Papanicolaou smears with inadequate or absent endocer vical cells was determined before and after employment of a collection technique using a spatula and Cytobrush. We measured the rate of less than optimal Papanicolaou smears due to too few or absent endocervica l cells. Results: Before implementing the new collection technique ful ly by June 1990, the overall rate of less than optimal cervical Papani colaou smears ranged from 20-25%; by December 1993, it had stabilized at about 10%. Conclusion: Continuous quality improvement can be used s uccessfully to study a clinical process and implement change that will lead to improvement.