Difference between revisions of "Level 4 equivalent of 2014"

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'''Level 4 equivalent''', abbreviated '''L4E''', is a [[workload measurement system]] endorsed by the Canadian Association of [[pathologist]]s.<ref name=pmid15762279>{{Cite journal  | last1 = Maung | first1 = RT. | title = What is the best indicator to determine anatomic pathology workload? Canadian experience. | journal = Am J Clin Pathol | volume = 123 | issue = 1 | pages = 45-55 | month = Jan | year = 2005 | doi =  | PMID = 15762279 }}</ref>
'''Level 4 equivalent of 2014''', abbreviated '''L4E (2014)''', is a [[workload measurement system]] endorsed by the Canadian Association of [[pathologist]]s.<ref name=Can_J_Pathol_2010_2_8-19>{{Cite journal  | last1 = Maung | first1 = R. | title = [http://andrewjohnpublishing.com/images/cjp%202-1.pdf Canadian Association of Pathologists guidelines for measurement of workload] | journal = Canadian Journal of Pathology | volume = 2 | issue = 1 | pages = 8-19 | month = | year = 2010 | doi =  | PMID = }}</ref>


==Details==
The development is described in a paper by Maung published in 2010.<ref name=pmid15762279>{{Cite journal  | last1 = Maung | first1 = RT. | title = What is the best indicator to determine anatomic pathology workload? Canadian experience. | journal = Am J Clin Pathol | volume = 123 | issue = 1 | pages = 45-55 | month = Jan | year = 2005 | doi =  | PMID = 15762279 }}</ref>
===Surgical pathology===
 
L4E units for surgical pathology adapted from Maung:<ref name=pmid15762279/>
The original system is covered in the article ''[[Level 4 equivalent of 2010]]''.  The 2014 version (dealt with here) is superseded by the 2018 version which is dealt with in ''[[Level 4 equivalent of 2018]]''.
 
==Revised L4E of 2014==
One L4E unit is considered to be roughly equivalent to 10 minutes.
 
===Most surgical pathology===
As per L4E definition (2014) adapted from CAP-ACP:<ref name=capacp2014>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 https://www.cap-acp.org/cmsUploads/CAP/File/CAP-ACP%202014%20Workload%20FINAL.pdf]. Accessed on: 17 October 2017.</ref>  
{| class="wikitable sortable"
{| class="wikitable sortable"
! Code
! L4E units 
! Description
! Description
! L4E units
! Details
|-
|-
| Surgical - level 1
| L1
| 0.15
| 0.15
| gross only specimens
| itemized in the "specimen list and codes"
|-
|-
| Surgical - level 2
| L2
| 0.33
| 0.333
| confirmation of normal
| must include histology
|-
|-
| Surgical - level 3
| L3
| 0.5
| 0.5
| small/simple biopsies
| includes most skin, cysts, GI tract specimens, small benign specimens - detailed in [[L4E rule 1-3 (2014)|rules 1, 2 and 3]]
|-  
|-  
| Surgical - level 4
| L4
| 1.0
| 1
| biopsies - most internal organs
| detailed in [[L4E rule 1-3 (2014)|rules 1, 2 and 3]]
|-  
|-  
| Surgical - level 5
| L5
| 5.0
| 5
|-
| complex biopsies
| Surgical - level 6
| includes medical and transplant biopsies, explant organs
| 15.0
|-  
|-  
| L6
| 10
| radical resections for malignancy
| detailed in [[L4E rule 9 (2014)|rule 9]]
|-
|}
|}


Modifiers to the base scores (above) - based on Maung:<ref name=pmid15762279/>
====All other surgical pathology cases====
As per L4E definition (2014) adapted from CAP-ACP:<ref name=capacp2014/>
{| class="wikitable sortable"
{| class="wikitable sortable"
! L4E units
! Description
! Description
! L4E units
! Details
|-
|-
| Additional stains & IHC<br>>=4 for case
| L2/block
| +1.0
| non-radical and benign resections, non-biopsy/non-L6 cases
|-  
| 10 blocks = 10 x L2; 10 x L2 = 3.33 L4Es; details in [[L4E rule 4 (2014)|rule 4]]
| Immunofluorescence
|}
| +0.5
 
===Cytopathology===
As per L4E definition (2014) adapted from CAP-ACP:<ref name=capacp2014/>
{| class="wikitable sortable"
! Code
! L4E units
! Description
! Details
|-
|-
| [[Intraoperative consultation]]
| C1
| 3
| 1
| simple (exfoliative) cytology
| pap test, urine, sputum, fluids (peritoneal, pleural)
|-
|-
| Each additional<br> [[intraoperative consultation]]
| C2
| 2
| 2
| complex cytology
| FNAs, brushes, washes
|-
|}
|}
===Additional block/levels===
Deeper cuts and the submission of additional tissue are dealt with in [[L4E rule 6 (2014)|rule 6]].
===Special stains and IHC===
Special stains and immunostains are dealt with in [[L4E rule 7-8 (2014)|rule 7 and rule 8]].
===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===  
===Total workload===  
Recommended mean workload per pathologist adapted from Maung:<ref name=pmid15762279/>
Recommended workload per pathologist:<ref name=capacp2014/>
{| class="wikitable sortable"
{| class="wikitable sortable"
! Practise type
! Mean annual L4E units
! Annual L4E units <br>(mean & standard deviation)
! Lower bound ‡
|-
! Upper bound ‡
| Rural
| 5,589 (5,393-5,784)
|-
|-
| Independent
| 7560
| 6,316 (6,095-6,537)
| 7115
| 8089
|-
|-
| Specialized
| 7,043 (6,797-7,290)
|}
|}
‡ 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==
==See also==
*[[Workload measurement]].
*[[Workload measurement]].
*[[Level 4 equivalent of 2010]].
*[[L4E rules of 2014]].
*[[L4E quizzes]].


==References==
==References==

Latest revision as of 22:39, 19 May 2019

Level 4 equivalent of 2014, abbreviated L4E (2014), 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 original system is covered in the article Level 4 equivalent of 2010. The 2014 version (dealt with here) is superseded by the 2018 version which is dealt with in Level 4 equivalent of 2018.

Revised L4E of 2014

One L4E unit is considered to be roughly equivalent to 10 minutes.

Most surgical pathology

As per L4E definition (2014) adapted from CAP-ACP:[3]

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:[3]

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:[3]

Code L4E units Description Details
C1 1 simple (exfoliative) cytology pap test, urine, sputum, fluids (peritoneal, pleural)
C2 2 complex cytology FNAs, brushes, washes

Additional block/levels

Deeper cuts and the submission of additional tissue are dealt with in rule 6.

Special stains and IHC

Special stains and immunostains are dealt with in rule 7 and rule 8.

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:[3]

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

  1. Maung, R. (2010). "Canadian Association of Pathologists guidelines for measurement of workload". Canadian Journal of Pathology 2 (1): 8-19.
  2. 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.
  3. 3.0 3.1 3.2 3.3 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.