North Texas Research Forum 2024



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North Texas


Medical City Fort Worth



Document Type


Publication Date



quality improvement, skin biopsy, lesion diameter


Dermatology | Diagnosis | Medicine and Health Sciences | Quality Improvement | Skin and Connective Tissue Diseases


Background: Skin biopsy requisition forms (SBRFs) are the primary communication tool between dermatologists and dermatopathologists. Diameters of biopsied skin lesions are frequently omitted on SBRFs. This quality improvement project aimed to increase the rate of reporting diameters of neoplasms on SBRFs from an academic dermatology outpatient clinic to greater than 65% within three years. Methods: The Plan-Do-Study-Act model was utilized. An initial audit was performed for SBRFs of biopsies obtained between July 1, 2021, and February 4, 2022 (“Cycle 1”). On February 4, 2022, the authors discussed societal guidelines for lesion diameter reporting on SBRFs (“Intervention A”). Cycle 2 prospectively evaluated the efficacy of Intervention A by analyzing SBRFs from February 5, 2022, to June 14, 2022. Starting March 28, 2023, select SBRFs were physically stamped with visible reminders to include lesion diameter (“Intervention B”). Cycle 3 prospectively assessed the efficacy of Intervention B through SBRFs analyzed from March 28, 2023, to June 30, 2023. On July 1, 2023, a peer orientation, including Interventions A and B, was conducted for a new resident dermatologist (“Intervention C”). Cycle 4 prospectively evaluated the efficacy of Intervention C by analyzing SBRFs between July 1, 2023, to November 30, 2023. Results: Cycle 1 found 8.25% (49/594) of skin biopsies included lesion diameters on SBRFs. In Cycle 2, the reporting rate increased to 49.71% (85/171) in the intervention group, significantly higher than that of the control group (1.73%, 5/289). In Cycle 3, reporting rate increased in both the intervention (84.13%, 53/63) and control (26.80%, 78/291) groups. Cycle 4 saw further increases in the intervention (87.78%, 79/90) and control (37.62%, 155/412) group reporting rates. Conclusions: Each intervention increased lesion diameter reporting rate on SBRFs. Our interventions overcome common barriers to incorporating guidelines to improve quality (eg, inertia of previous practice, external barriers).

Original Publisher

HCA Healthcare Graduate Medical Education

Improving Lesion Diameter Reporting on Skin Biopsy Requisition Forms: A Quality Improvement Project



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