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Difference between revisions of "Level 4 equivalent of 2018"
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'''Level 4 equivalent''', abbreviated '''L4E''', 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> | |||
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> The system was revised in 2014 and is comprehensive with regard to academic practice and community practice.<ref>URL: [https://www.cap-acp.org/wkload.php https://www.cap-acp.org/wkload.php]. Accessed on: 14 July 2017.</ref> | |||
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]]''. | |||
==Revised 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:<ref name=capacp2018>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 https://www.cap-acp.org/cmsUploads/CAP/File/CAP-ACP_Workload_Model_2018_Final_2020180907(1).pdf]. Accessed on: 19 May 2019.</ref> | |||
{| class="wikitable sortable" | |||
! 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 [[L4E rule 1-3 (2018)|rules 1, 2 and 3]] | |||
|- | |||
| L4 | |||
| 1 | |||
| biopsies - most internal organs | |||
| detailed in [[L4E rule 1-3 (2018)|rules 1, 2 and 3]] | |||
|- | |||
| L5 | |||
| 5 | |||
| complex biopsies | |||
| includes medical and transplant biopsies, explant organs | |||
|- | |||
| L6 | |||
| 10 | |||
| radical resections for malignancy | |||
| detailed in [[L4E rule 9 (2018)|rule 9]] | |||
|} | |||
====All other surgical pathology cases==== | |||
As per L4E definition (2018) adapted from CAP-ACP:<ref name=capacp2018/> | |||
{| class="wikitable sortable" | |||
! 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 [[L4E rule 4 (2018)|rule 4]] | |||
|} | |||
===Cytopathology=== | |||
As per L4E definition (2018) adapted from CAP-ACP:<ref name=capacp2018/> | |||
{| class="wikitable sortable" | |||
! 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 [[L4E rule 6 (2018)|rule 6]]. | |||
===Special stains and IHC=== | |||
Special stains and immunostains are dealt with in [[L4E rule 7-8 (2018)|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:<ref name=capacp2018/> | |||
{| class="wikitable sortable" | |||
! 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== | |||
{{Reflist|1}} | |||
[[Category:Quality]] | |||