Anatomic pathology quality assurance program

By leveraging your whole-slide imaging platform investment, users benefit from reducing the overhead of internal QA processes and receiving feedback to improve their practice proficiency. A hepatic , gastro-intestinal and solid- organ transplant pathologist by training, Dr. Markin serves as the chief technology officer of the University of Nebraska Medical system, associate vice chancellor for business development for the University of Nebraska Medical Center, [6] and executive director of the UNeTech Institute of the University of Nebraska Medical Center and the University of Nebraska Omaha.

He serves as both the David T. Mark has implemented global quality control and assurance programs in chemistry, immunochemistry, blood banking and hematology.

At QualityStar we seek people who want to challenge the status quo and provide momentum to the accuracy of the diagnostic process and outcomes. Mikroscan delivers a suite of digital pathology solutions to further help pathologists collaborate, consult, and communicate, without being bound by the geographical limitations of physical glass slides.

San Diego, CA. Read More ». Subspecialty pathologist review of cases may result in consistent adherence to established diagnostic criteria, pathologists' ability to correlate objective pathologic tissue data with subjective and objective clinical information, and the ability to provide a "common language" to facilitate ease of communication of the pathology report.

Consultative Review Consultative review of pathology materials second opinions is an essential component of total quality assurance programs in diagnostic surgical pathology and cytopathology Tomaszewski, et al. This key aspect in the assurance of patient safety for tissue- and cytology-based diagnoses is likely to be the most accurate and cost-effective when a program combines: prospective intradepartmental review of cases, retrospective intradepartmental review of diagnoses rendered, selected utilization of inter-institutional second opinions referred to pathologists with subspecialty expertise within specific organ systems and disease categories, and mandatory review of pathology materials in which the diagnosis was reported at external institutions when patients are referred for definitive therapy within the "home" institution Tomaszewski, et al.

Consensus conference activities within the department to set standards and "thresholds" for diagnosis. Is this formal or informal training? Is the intradepartmental consultation directed to pathologists with subspecialty expertise or distributed among the pathologists in another manner?

What are the rates of minor and major discrepancies among the pathologists? How are the discrepancies resolved? Extra-departmental Inter-institutional review Policies to institute: Mandatory review of any outside pathology materials upon which a definitive therapy is planned within a referral institution. External consultation by subspecialty pathologists required on no less than 0. Within a community hospital with 20, cases each year, this results in cases for consultation each year; roughly 2 cases per week.

Inquiries to the pathologist and department: What is the ratio of inter-institutional consultation performed a at the request of the patient, b at the request of the clinician, c at the request of the treating institution and d at the request of the pathologist rendering the original diagnosis?

Does the pathology department utilize a specific set of preferred consultants who are recognized experts within each subspecialty? Alternately, do the referral cases get "sent to the university," without specifying a consultant pathologist?

What is the rate of diagnostic agreement? Minor disagreement? Major disagreement? With the consulting pathologist? How are these discrepancies resolved? Summary Because therapeutic decisions are based on the presumed reliability of the pathology diagnosis, a misdiagnosis can result in unnecessary, harmful and aggressive therapy, or inadequate treatment. The financial cost of errant pathology diagnoses in terms of unnecessary treatment, wrong treatment, repeat physician visits and procedures, lost income, and morbidity and death has not been collectively documented, but is estimated to be substantial.

Despite the fact that several studies have demonstrated the cost-efficiency of expert consultation second opinions in pathology, reimbursement for inter-institutional consultation has been reduced or excluded by some third party payers during the age of managed care and cost containment. Considering the coming wave of pay for performance and evidence-based outcome measures, the effect of errant pathology diagnoses on the ability of clinical physicians to meet the performance standards has yet to be determined.

Increased demand for medical care is quickly outpacing supply of services. To meet the increasing demand without compromising quality, integration of subspecialty pathologists within general pathology practices, utilization of subspecialty pathology services, or liberal utilization of expert consultation by experienced subspecialty pathologists within other institutions may increase the baseline diagnostic accuracy of pathology evaluations.

In the era of consumerism, advocating increased access to subspecialty care for both patients and clinicians referring their patients to pathologists, who can demonstrate measurable outcomes, can provide a real means of reducing costs, improving efficiency, and providing exemplary care. Julia Dahl is board certified in anatomic and clinical pathology.

She is a practicing gastrointestinal and hepatic pathologist and chief medical officer of Mosaic Gastrointestinal and Hepatic Research Consortium in Tennessee. Dahl received her gastrointestinal and hepatic pathology fellowship training at the University of Washington Medical Center under the tutelage of the late Rodger C.

Haggitt, M. Rubin, M. Bronner, M. Taylor, M. Dahl has been involved with hospital and outpatient pathology laboratory quality assurance program development and ongoing activities since her pathology residency at the Providence Health System in Portland, Oregon.

She may be contacted at jdahlmd mosaicgi. References Bejarano, P. Second opinion in liver biopsy interpretation. American Journal of Gastroenterology, 96 11 , Coblentz, T. Impact of second opinion pathology in the definitive management of patients with bladder carcinoma. Farmer, M. The importance of diagnostic accuracy in colonic inflammatory bowel disease.

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Kronz, J. Mandatory second opinion surgical pathology at a large referral hospital. Lind, A. Prospective peer review in surgical pathology. American Journal of Clinical Pathology, 5 , Renshaw, A. Agreement and error rates using blinded review to evaluate surgical pathology of biopsy material. American Journal of Clinical Pathology, 6 , Roche, W. Lab mistakes threaten credibility, spur lawsuits: Some top medical facilities are scrutinized as errors mount and oversight is questioned.

Los Angeles Times. Santoso, J. L, Voet, R. Pathology slide review in gynecologic oncology. Sarewitz, S. Laboratory accreditation program inspection checklists. College of American Pathologists. Selman, A. Quality assurance of second opinion pathology in gynecologic oncology. Staradub, V. Changes in breast cancer therapy because of pathology second opinions.