Level 4 equivalent of 2014
Level 4 equivalent, abbreviated L4E, is a workload measurement system endorsed by the Canadian Association of pathologists.[1]
The development is described in a paper by Maung published in 2010.[2] The system was revised in 2014 and is comprehensive with regard to academic practice and community practice.[3]
This article covers the 2014 revision of L4E. The original system is covered in the article Level 4 equivalent of 2010.
Revised L4E of 2014
Most surgical pathology
As per L4E definition (2014) adapted from CAP-ACP:[4]
| Code | L4E units | Description | Details |
|---|---|---|---|
| L1 | 0.15 | gross only specimens | itemized in the "specimen list and codes" |
| L2 | 0.333 | confirmation of normal | must include histology |
| L3 | 0.5 | small/simple biopsies | includes most skin, cysts, GI tract specimens, small benign specimens - detailed in rules 1, 2 and 3 |
| L4 | 1 | biopsies - most internal organs | detailed in rules 1, 2 and 3 |
| L5 | 5 | complex biopsies | includes medical and transplant biopsies, explant organs |
| L6 | 10 | radical resections for malignancy | detailed in rule 9 |
All other surgical pathology cases
As per L4E definition (2014) adapted from CAP-ACP:[4]
| L4E units | Description | Details |
|---|---|---|
| L2/block | non-radical and benign resections, non-biopsy/non-L6 cases | 10 blocks = 10 x L2; 10 x L2 = 3.33 L4Es; details in rule 4 |
Cytopathology
As per L4E definition (2014) adapted from CAP-ACP:[4]
| Code | L4E units | Description | Details |
|---|---|---|---|
| C1 | 1 | simple (exfoliative) cytology | pap test, urine, sputum, fluids (peritoneal, pleural) |
| C2 | 2 | complex cytology | FNAs, brushes, washes |
Adjustments for micro only and teaching
The workload is adjusted if the gross is not done by the pathologist or teaching is done as part of the sign-out.
Cases where the gross is not done by the pathologist are discounted 5%. Cases that include teaching are given a 30% premium.
Total workload
Recommended workload per pathologist:[4]
| Mean annual L4E units | Lower bound ‡ | Upper bound ‡ |
|---|---|---|
| 7560 | 7115 | 8089 |
‡ Defined by mean +/- 2 standard deviations.
If one presumes 210 working days, on the basis 6 weeks vacation + 2 week CME + 10 stat holidays, the daily mean workload is 36 L4E.
See also
References
- ↑ Maung, R. (2010). "Canadian Association of Pathologists guidelines for measurement of workload". Canadian Journal of Pathology 2 (1): 8-19.
- ↑ Maung, RT. (Jan 2005). "What is the best indicator to determine anatomic pathology workload? Canadian experience.". Am J Clin Pathol 123 (1): 45-55. PMID 15762279.
- ↑ URL: https://www.cap-acp.org/wkload.php. Accessed on: 14 July 2017.
- ↑ 4.0 4.1 4.2 4.3 Workload and Workforce Committee of the CAP-ACP. Workload Measurement Guidelines. Canadian Association of Pathologists (CAP-ACP). 2014. URL: https://www.cap-acp.org/cmsUploads/CAP/File/CAP-ACP%202014%20Workload%20FINAL.pdf. Accessed on: 17 October 2017.