Level 4 equivalent of 2018
Level 4 equivalent, abbreviated L4E, is a workload measurement system endorsed by the Canadian Association of pathologists.[1]
This article covers the 2018 revision of L4E. The original system is covered in the article Level 4 equivalent of 2010. The 2014 version is covered in Level 4 equivalent of 2014.
Overview
It is comprehensive with regard to academic practice and community practice.[2]
History
The development is described in a paper by Maung published in 2010.[3] The system was revised in 2014 and 2018.
L4E of 2018
One L4E unit is considered to be roughly equivalent to 10 minutes.
Most surgical pathology
As per L4E definition (2018) adapted from CAP-ACP:[4]
| Code | L4E units | Description | Details |
|---|---|---|---|
| L1 | 0.125 | gross only specimens | itemized in the "specimen list and codes" |
| L2 | 0.25 | 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 (2018) adapted from CAP-ACP:[4]
| L4E units | Description | Details |
|---|---|---|
| L2/block | non-radical and benign resections, non-biopsy/non-L6 cases | 12 blocks = 12 x L2; 10 x L2 = 3 L4Es; details in rule 4 |
Cytopathology
As per L4E definition (2018) adapted from CAP-ACP:[4]
| Code | L4E units | Description | Details |
|---|---|---|---|
| C1 | 1 | all cytology, except fine needle aspirations (FNAs) | pap test, urine, sputum, fluids (peritoneal, pleural) |
| C2 | 2 | fine needle aspirations (FNAs) |
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:[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
- Workload measurement.
- Level 4 equivalent of 2010.
- Level 4 equivalent of 2014.
- L4E rules of 2018.
- L4E quizzes.
References
- ↑ Maung, R. (2010). "Canadian Association of Pathologists guidelines for measurement of workload". Canadian Journal of Pathology 2 (1): 8-19.
- ↑ URL: https://www.cap-acp.org/wkload.php. Accessed on: 19 May 2019.
- ↑ 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.
- ↑ 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). 2018. URL: https://www.cap-acp.org/cmsUploads/CAP/File/CAP-ACP_Workload_Model_2018_Final_2020180907(1).pdf. Accessed on: 19 May 2019.