Bone marrow aspirate quality assessment.

76 Background: Bone marrow evaluation is the cornerstone of diagnosis, staging, and measurement of treatment response for many hematologic diseases. Aspirate adequacy is defined by whether the procedure results in a specimen of sufficient quality for pathologic review. Between July 1, 2014 and June 30, 2015, 49.3% of inpatient bone marrow aspirates performed by Hematology/Oncology fellows at Columbia University Medical Center were classified as suboptimal. Methods: We used the Plan-Do-Study-Act methodology to 1) understand the factors contributing to suboptimal aspirates, 2) evaluate the scope of the problem at both fellowship and institutional levels, 3) develop a training seminar to educate fellows on the procedure techniques, and 4) monitor for improvement post-intervention. We identified inpatient bone marrow biopsies performed by Hematology/Oncology fellows between July 1, 2015 and June 30, 2016 and tabulated aspirate adequacy as noted in the reports. A faculty-led educational seminar was held on February 1, 2016. Fellows completed a pre- and post-intervention survey to assess knowledge and experience with bone marrow aspirates. Bone marrow biopsy billing data was used as a surrogate marker for attending supervision. Results: All Hematology/Oncology fellows (n = 19) at Columbia University Medical Center participated. The pre-intervention survey (18 responses; 94.7%) revealed 76.5% of fellows had formal bone marrow aspirate training, 66.6% had supervision 25% to 75% of the time, and 52.9% were uncomfortable performing the procedure alone. Of the 43 aspirates from the pre-intervention period, 22 (51.2%) were adequate. 94.7% of fellows attended the training seminar. Post-intervention, 27 of 50 (54%) bone marrow aspirates were adequate. The post-intervention survey (16 responses; 84.2%) showed 93.3% of fellows were confident performing the procedure alone. There were fewer procedures billed in the post-intervention period (20.9% pre vs 8% post). Conclusions: A formal educational seminar on bone marrow aspirate technique increased fellow comfort with the procedure and trended toward improved aspirate adequacy. The next study phase will institute an annual training session for incoming fellows and create a bone marrow specimen preparation checklist.