quality control in surgical pathology

[pathomatic]

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Hi everyone,
I just attended a very interesting talk on quality control in surgical pathology at my home institution. The topic of grossing errors on the part of residents and PAs came up, the kind of errors that I am talking about ranges from minor ones like submitting thick sections to more egregious ones like mislabeling cassettes or patient specimen mix up. I feel that constant feedback on your mistakes in the form of an online reporting tool where the number of mistakes that you commit is graphed against an average number of mistakes for all residents and PAs for a specific time period (week or a month) (e.g. how constantly do you submit thick sections and how constantly do your sections need to be reprocessed) would be very useful and improve the quality of patient care. Does anyone know of such an online tool ? Any other ideas ?, how do you implement quality control for such things at your institution? Any feedback would be appreciated...

 

[Granular]

You hit a nerve. When I started grossing, I made "mistakes", like putting in sections that were too thick. However, the errror rate, as judged by histology, was dependent on other factors, like how busy they were. If they wanted to work less, they would not process "thick" sections, or they would page residents to tell them that their adipose-rich sections needed to be reprocessed. When the crappy equipment that labelled our cassettes did not work (about 40% of the time), we hand-wrote our cassettes, and if the histotechs did not want to work, they would smudge a couple of numbers on the cassette and leave it for the resident to figure out what it is. BTW, when the labelling machine did not work, our "error rate" went up, because more numbering had to be done manually. So whose mistake is that, really? Overworked resident grossing mules who are just trying to learn some pathology, or the penny-pinching administrators who buy unreliable crap and then get promoted for saving money? I am pretty sure the administrators don't get named in those lawsuits when two breast biopsies are mixed up.
The errors were documented (I am pretty sure this is a QA/QC requirement) manually, with supervisors filling out some sheet with a description of the "incident," but this was usually something more than a thick section, like a labelling error. There is no way this fairly reflected the work of the residents; the grossing techs made fewer "mistakes," but they grossed about 1/4 of what the residents grossed, and their cases were much simpler. Unless the error rate is normalized to productivity, I would object to some automated error tracking system. Also, the subjectivity of what constitutes an error needs to be reduced. Maybe a grading system, on a scale of 1+ to 4+, dependent on the severity of the mistake...