Quality in Surgical Pathology- A Story of Continuous Improvement Over Seven Years at Rural Teaching Hospital in Western India EC06-EC10
Dr. Kailash Inaniya,
C-4/19, Staff Quarters, Shree Krishna Hospital, Karamsad, Gujarat, India.
Introduction: Quality assurance in histopathology is a long sought phenomenon with a limited objectiveness and well defined quality parameters. We tried to design, implement and monitor a Quality Improvement Plan of histopathology with target based approach and required interventions.
Aim: To establish and implement Quality Improvement Plan in histopathology, to identify various error rates, their reduction strategies and to assess scope for improvement in histopathology services.
Materials and Methods: Various defined parameters of pre-analytical, analytical and post-analytical phases of quality were implemented and monitored with necessary corrective and preventive actions to improve the outcome over a period of seven years.
Results: The study included 24,266 samples. Pre-analytical indicators showed improvement over a period of time with good performance in area of specimen fixation, specimen delivery, and completeness of requisition form and slide quality. The analytical phase showed continuous improvement in various correlations and error rates. A discordance rate of 1.09% was found in histopathology-frozen section correlation and 6.6% for histopathology-cytology correlation. Histopathology-IHC correlation rate was 87.1% and 0.2% cases showed discordance in internal peer review. Incomplete reports were found in 0.024%. In post-analytical phase, the total amended reports were 0.25%. A 96.8% of all critical alerts were intimated to clinicians. The Turn Around Time (TAT) outliers were 0.78%. External Quality Assurance Scheme (EQAS) performance was 76.3% and 97.7% for pre-analytical and analytical phase respectively.
Conclusion: The effective quality improvement plan for surgical pathology can be successfully implemented at rural teaching hospital by designing a plan and executing it with continuous monitoring and necessary intervention.