Synopsis
Quality in surgical pathology includes the production of reports that are accurate, timely, and thorough. Quality assurance is critical in all fields; in surgical pathology, it is even more vital because the discipline revolves around patient care and treatment planning. Significant investment is needed in the foundational infrastructure to achieve high-level standards and to maintain quality service. The effectiveness of quality assurance and improvement is maximized when the desire to achieve it is integrated into the processes of surgical pathology, supported by staff who are well-informed, well-trained, and knowledgeable. Working with the best team is one of the most important aspects of this whole workflow, as it is a team effort that pays off. The other side of the coin is a well-organized quality assurance system in place. This article will explore the quality assurance angle and its role in contributing to the success of surgical pathology laboratories and institutions.
Quality Assurance in Surgical Pathology
Having quality assurance in surgical pathology means delivering comprehensive reports on time. To achieve and maintain quality output, you need to be ready for substantial investment in the basic structure and in the people who undertake surgical pathology tasks. Quality assurance in surgical pathology is achieved when well-informed, well-trained, and knowledgeable staff are involved in the process.
How to Define Quality in Surgical Pathology?
Experts are often lost when they need to explain the concept of quality in surgical pathology. Elements of quality that are important in surgical pathology mostly include report accuracy, timeliness, and report completeness. Typical quality assurance and improvement plans contain five categories of monitoring.
- Pre-analytic: Specimen fixation, specimen delivery, specimen identification, adequacy of clinical history, accessioning errors.
- Analytic: Intra-operative, frozen section (permanent section concordance), final diagnosis (peer review error rate), histology and gross room monitors (block labeling errors, slide labeling errors, slide quality), immunohistochemistry (frequency of repeat slides, annual inventory of antibodies and frequency of use, external validation of selected antibodies), other ancillary study monitors include monitors for FISH, EM, and other molecular studies.Â
- Post-analytic: Transcription errors, verification errors, report delivery errors, incomplete reports, diagnostic finding correlation with ancillary studies (IHC, EM, FISH).Â
- Turnaround Time (TAT): Frozen section, biopsy, large specimen, preliminary and final necropsy reports.Â
- Clinician Satisfaction and Complaints: Overall satisfaction, diagnostic accuracy, frozen section timeliness, and accuracy, report timeliness, report completeness, pathologist availability, and recent changes.Â
Timeliness in Quality Assurance
Timeliness is entirely addressed by TAT monitors. You need to measure the whole process from the clinician’s perspective. In the pre-analytic phase, several elements may be monitored. Patient or specimen identification is the most vital of them all. The specimen must be reported against the correct patient; this begins with specimen labeling and accessioning.
Multifactorial Analysis
Multifactorial analysis involves external resources. The analytic phase begins with the gross examination of the specimen and ends with diagnosis. All manipulations that lead to diagnosis, like immunohistochemistry, are part of the analytic phase components. The post-analytic phase of the test cycle begins with the dictation of the gross and microscopic examination and the final diagnosis. It includes transcription, report correction, verification, and report delivery. Key things in the post-analytic phase include accurate transcription, complete reporting, and report delivery.
Quality Assurance in Laboratory
Quality assurance and improvement plans are vital components to maintain a high-standard laboratory. Quality in surgical pathology depends on various structural and personnel factors, which are essential regardless of any Quality Assurance and Improvement (QA&I) plan in place. If you want to achieve the best results in your laboratory, a quality assurance and improvement plan must be part of all the workflows and day-to-day activities.
Approaches for Quality Measuring
In measuring quality, surgical pathology experts use the following approaches:Â
- Intradepartmental consultationÂ
- Intraoperative consultationÂ
- Random case review Â
- Clinical indicatorsÂ
- Intra and interdepartmental conferencesÂ
- Pathology turnaround timesÂ
- Specimen adequacy and histology QCÂ
Intradepartmental consultation is performed through a review of selected cases by the diagnostic staff or by a second staff pathologist or consultant. When the entire case is evaluated by the consultant, it is recommended that both pathologists sign the report. When only a portion of the case has been reviewed, it is recommended that a note to that effect be added to the report. In intraoperative consultation, it is recommended that all cases are carried out regularly and are placed according to their final disposition. Â
Case Reviews
The review should include all material related to cases, including the final report, microscopic slides, turnaround time, and special procedures. In the case of clinical indicators, it is recommended that they are selected regularly based on organ/lesion or procedure. This activity should be rotated among surgical pathology and autopsy cases. In random case review, it is recommended that the following cases be reviewed on a random basis:Â
- Surgical pathology: 1% or 25/month, whichever is larger.Â
- Autopsy: 10% or two per month, whichever is larger.Â
Presenting Cases
When cases are presented at intra- and inter-departmental conferences, it is recommended that the diagnosis listed in the final report be compared with the one made by the final presenter when reviewing the case for the conference. When talking about turnaround times, 1-3 days are usually taken. Reports also need to involve specimen adequacy, irreversible loss of a surgical pathology specimen, and histology quality.
Artificial Intelligence in Quality Assurance
Artificial intelligence (AI) is increasingly being used for quality assurance. AI brings a lot of benefits. It is quick, efficient, and gives precise results. There are many AI platforms that surgical pathology experts use for the highest quality of work. PreciPoint’s PreciAI adopts digital microscopes and the AI. You can benefit from advanced features, increase accuracy and precision, and obtain greater convenience.
Conclusion
Quality assurance in surgical pathology brings out the best results that benefit you, the healthcare professional, and the patient. Being a complex topic, quality assurance needs to be approached strategically. That means employing the right set of resources who will do high-quality work, create error-free reports, and bring out the best results. Ideally, quality assurance in surgical pathology involves effective monitoring, which takes place in several phases. Experts measure quality through consultations and reviews, focusing on final reports, turnaround times, and specialized procedures. To ensure success, both the surgical pathology team and the entire laboratory must prioritize these aspects.Â
