Archives of Pathology and Laboratory Medicine--Special Section on Quality

http://www.ncbi.nlm.nih.gov/pubmed/22032561

Arch Pathol Lab Med. 2011 Nov;135(11):1384-6.
Quality: walk the walk.
Allen TC.

Abstract
The College of American Pathologists (CAP) is dedicated to pathology and laboratory medicine quality. The CAP's Laboratory Accreditation Program, Proficiency Testing Program, Q-Probes and Q-Tracks, site-specific cancer checklists, webinars, annual meetings, and Advanced Practical Pathology series are all focused on providing superior patient quality. The CAP is synonymous with quality in pathology and laboratory medicine. As pathology practice becomes more sophisticated, the CAP's many programs will increasingly help pathologists provide appropriate, personalized care.




http://www.ncbi.nlm.nih.gov/pubmed/22032562

Arch Pathol Lab Med. 2011 Nov;135(11):1387-90.
Quality improvement in cytology: where do we go from here?
Renshaw AA.

Abstract
Context.-Cytology is a success because of the many quality controls used to ensure the accuracy of its results. Nevertheless, additional information is becoming available to the cytologist, often from untraditional sources, and the best way to use that information to improve the quality of cytology is not yet known. Objective.-To review ways to use new information to improve the quality of cytology. Data Sources.-Review of relevant literature. Results.-Information contained in many sources can be used in new ways to improve the quality of cytology. These include the timing of cytologic and histologic correlation, electronic medical records, workload information, prior aspirations, and molecular tests. Conclusions.-To maintain their high standard of excellence, cytologists should seek to define the most appropriate way to incorporate this new information into their interpretation of individual cases.




http://www.ncbi.nlm.nih.gov/pubmed/22032563

Arch Pathol Lab Med. 2011 Nov;135(11):1391-3.
Unexpected expectations in critical values in anatomic pathology: improving agreement between pathologists and nonpathologists with the treatable immediately, life-threatening terminology.
Renshaw SA, Gould EW, Renshaw AA.

Abstract
Context.-The degree to which critical values in anatomic pathology are understood in the nonpathology community is not know. Objective.-To measure the degree of agreement between pathologists and nonpathologists regarding critical values in anatomic pathology. Design.-A survey containing 15 anatomic pathologic diagnoses was given to a group of pathologists and nonpathologists who were then asked to state whether they should be regarded as critical values. Results.-Nonpathologists thought that a significantly greater percentage of diagnoses were critical than did pathologists, (49% versus 12%, P < .001). If the term critical value was changed to treatable immediately, life threatening, there was no significant difference between the responses of nonpathologists and pathologists (20% versus 12%, P  =  .06). Conclusions.-There is considerable disagreement between pathologists and nonpathologists concerning which diagnoses are critical values in anatomic pathology. Use of the term treatable immediately, life threatening significantly improves agreement.




http://www.ncbi.nlm.nih.gov/pubmed/22032564

Arch Pathol Lab Med. 2011 Nov;135(11):1394-7.
Quality in surgical pathology communication and reporting.
Nakhleh RE.

Abstract
Context.-Communication in surgical pathology is complex and includes multiple facets. Objective.-To discuss different aspects of pathology practice that represent quality communication in surgical pathology. Data Sources.-Literature review. Conclusions.-Achieving quality communication in surgical pathology is dependent on pathologists addressing multiple situations including managing physicians' expectations for turnaround time and ancillary testing, understanding what information is needed to manage the patient at intraoperative consultation and in the final report, assuring adequate report content with the use of synoptic checklist reports, and using report formatting suggestions that aid report comprehension. Finally, the pathologists' availability to answer questions and discuss cases is an important factor in effective communication, including their willingness to verbally report urgent and significant unexpected diagnoses to ensure that important diagnoses are not overlooked.




http://www.ncbi.nlm.nih.gov/pubmed/22032565

Arch Pathol Lab Med. 2011 Nov;135(11):1398-404.
Evidence-based principles in pathology: existing problem areas and the development of "quality" practice patterns.
Wick MR, Marchevsky AM.

Abstract
Context.-Contrary to the intuitive impressions of many pathologists, several areas exist in laboratory medicine where evidence-based medicine (EBM) principles are not applied. These include aspects of both anatomic and clinical pathology. Some non-EBM practices are perpetuated by clinical "consumers" of laboratory services because of inadequate education, habit, or overreliance on empirical factors. Other faulty procedures are driven by pathologists themselves. Objectives.-To consider (1) several selected problem areas representing non-EBM practices in laboratory medicine; such examples include ideas and techniques that concern metastatic malignancies, "targeted" oncologic therapy, general laboratory testing and data utilization, evaluation of selected coagulation defects, administration of blood products, and analysis of hepatic iron-overload syndromes; and (2) EBM principles as methods for remediation of deficiencies in hospital pathology, and implements for the construction of "quality" practices in our specialty. Data Sources.-Current English literature relating to evidence-based principles in pathology and laboratory medicine, as well as the authors' experience. Conclusions.-Evidence-based medicine holds the promise of optimizing laboratory services to produce "quality" practices in pathology. It will also be a key to restraining the overall cost of health care.




http://www.ncbi.nlm.nih.gov/pubmed/22032566

Arch Pathol Lab Med. 2011 Nov;135(11):1405-14.
Assuring Quality in Point-of-Care Testing: Evolution of Technologies, Informatics, and Program Management.
Lewandrowski K, Gregory K, Macmillan D.

Abstract
Context.-Managing the quality of point-of-care testing (POCT) is a continuing challenge. Advances in testing technologies and the development of specialized informatics for POCT have greatly improved the ability of hospitals to manage their POCT program. Objectives.-To present the evolving role of technology improvement, informatics, and program management as the key developments to ensure the quality of POCT. Data Sources.-This presentation is based on a review of the literature and on our experiences with POCT at the Massachusetts General Hospital (Boston). Conclusions.-Federal and state regulations, along with accreditation standards developed by the College of American Pathologists and The Joint Commission, have established guidelines for the performance of POCT and have provided a strong incentive to improve the quality of testing. Many instruments for POCT have incorporated advanced design features to prevent analytic and operator errors. This, along with the development of connectivity standards and specialized data management software, has enabled remote review of test data and electronic flow of information to hospital information systems. However, documentation of manually performed, visually read tests remains problematic and some POCT devices do not have adequate safeguards to prevent significant errors. In the past 2 decades the structure of a successful POCT management program has been defined, emphasizing the role of POCT managers working in conjunction with a pathology-based medical director. The critical skill set of POCT managers has also been identified. The POCT manager is now recognized as a true specialist in laboratory medicine.




http://www.ncbi.nlm.nih.gov/pubmed/22032567

Arch Pathol Lab Med. 2011 Nov;135(11):1415-24.
Managing transfusion service quality.
Blaylock RC, Lehman CM.

Abstract
Context.-Providing blood products for transfusions is a complex process subject to errors both within and outside the transfusion service. Transfusion-related errors can have grave consequences for the patient undergoing transfusion. As with many processes performed within health care systems, there is an expectation of error-free practice. Although this is an unobtainable goal, a focused quality-management plan, employing a medical event reporting system in a just working environment, can effect measurable system-quality improvement. Objective.-To illustrate the intrinsic value of quality-improvement activities through discussion of examples of quality misadventures from our transfusion service during the past 20 years. Data Sources.-Examples of quality-improvement activities were extracted from our quality-system archives. The published literature on transfusion quality was reviewed. Conclusions.-Active reporting, structured investigation, and systematic resolution of transfusion-related errors are effective methods for improving and maintaining transfusion quality.




http://www.ncbi.nlm.nih.gov/pubmed/22032568

Arch Pathol Lab Med. 2011 Nov;135(11):1425-31.
Quality and safety in medical care: what does the future hold?
Liang BA, Mackey T.

Abstract
Context.-The rapid changes in health care policy, embracing quality and safety mandates, have culminated in programs and initiatives under the Patient Protection and Affordable Care Act. Objective.-To review the context of, and anticipated quality and patient safety mandates for, delivery systems, incentives under health care reform, and models for future accountability for outcomes of care. Design.-Assessment of the provisions of Patient Protection and Affordable Care Act, other reform efforts, and reform initiatives focusing on future quality and safety provisions for health care providers. Results.-Health care reform and other efforts focus on consumerism in the context of price. Quality and safety efforts will be structured using financial incentives, best-practices research, and new delivery models that focus on reaching benchmarks while reducing costs. In addition, patient experience will be a key component of reimbursement, and a move toward "retail" approaches directed at the individual patient may supplant traditional "wholesale" efforts at attracting employers. Conclusions.-Quality and safety have always been of prime importance in medicine. However, in the future, under health care reform and associated initiatives, a shift in the paradigm of medicine will integrate quality and safety measurement with financial incentives and a new emphasis on consumerism.




http://www.ncbi.nlm.nih.gov/pubmed/22032569

Arch Pathol Lab Med. 2011 Nov;135(11):1432-5.
College of american pathologists proposal for the oversight of laboratory-developed tests.
Vance GH.

Abstract
Context.-The US Food and Drug Administration (FDA) announced it will exercise authority over laboratory-developed tests (LDTs). Laboratory-developed tests have traditionally been developed and offered in laboratories as a service to patients and regulated under the Clinical Laboratory Improvement Amendments of 1988 (Clinical Laboratory Improvements Act). Laboratories now face potential dual regulatory oversight from both the Centers for Medicare and Medicaid Services (CMS) and the FDA. The College of American Pathologists (CAP) constructed a proposal to minimize redundancy of agency oversight and burden to laboratories. Modifications to the proposal continue while the laboratory community awaits release of the guidance documents that will stipulate FDA requirements. Objective.-To describe the historical context framing the entry of FDA into the oversight of LDTs and outline the CAP LDT Proposal in its current form. Data Sources.-PubMed review of published literature; United States Constitution; and online information resources from the National Institutes of Health, FDA, and US Government. Conclusion.-The College of American Pathologists is a leader in laboratory quality and has unique insights into the benefits and risks to patients presented by LDTs. Continued dialog with officials from the FDA and CMS will promote public and private collaborative efforts to assure innovation of diagnostic testing, public information, and patient safety for clinical diagnostic testing.




http://www.ncbi.nlm.nih.gov/pubmed/22032570

Arch Pathol Lab Med. 2011 Nov;135(11):1436-40.
Assessment of latent factors contributing to error: addressing surgical pathology error wisely.
Smith ML, Raab SS.

Abstract
Context.-Methods to improve surgical pathology patient safety include measuring the frequency of error in specific steps of the surgical pathology testing process, root cause analysis of active and latent components, and implementation of quality improvement initiatives. Objective.-To determine the frequency and cause of near-miss events in the specimen accessioning, setup, and biopsy-only gross examination testing steps of anatomic pathology. Design.-We used an observational checklist method to identify near-miss events. We performed root cause analysis to determine latent factors contributing to near-miss events. We conducted observations for 45 hours during 5 days, involving the accessioning and processing of 335 specimens. Results.-We detected a total of 2310 process-dependent and 266 operator-dependent near-miss events, resulting in a near-miss-event frequency of 5.5 per specimen. Root cause analysis showed that all process and operator near-miss events were associated with multiple system latent factors, including lack of standardized protocols, appropriate knowledge transfer, and focus on safety culture. Conclusion.-We conclude that the increased focus on surgical pathology near-miss events will reveal latent factors that may be targeted for improvement.




http://www.ncbi.nlm.nih.gov/pubmed/22032571

Arch Pathol Lab Med. 2011 Nov;135(11):1441.
Quality and the college of american pathologists.
Allen TC, Hammond ME, Robboy SJ.

Abstract
The College of American Pathologists (CAP) is dedicated to pathology and laboratory medicine quality. The CAP's Laboratory Accreditation Program, Proficiency Testing Program, Q-Probes and Q-Tracks, site-specific cancer checklists, webinars, annual meetings, and Advanced Practical Pathology series are all focused on providing superior patent quality. The CAP is synonymous with quality in pathology and laboratory medicine. As pathology practice becomes more sophisticated, the CAP's many programs will increasingly help pathologists provide appropriate, personalized patient care.