Audit in surgical histopathology at a tertiary healthcare center

Abstract

Context: An audit aims to verify conformance to required processes, assess their implementation, and define the targets of quality control. Aims: To evaluate preanalytic and analytic phases of surgical histopathology in a tertiary healthcare center. Setting and Design: An observational retrospective and prospective study over 3 months each of year 2013 and 2014. Materials and Methods: Biopsy, small resections, large organ resections, bone marrow aspirate/biopsy (BMA/BMB), and frozen section samples received in surgical histopathology were categorized as I to V, respectively. A manual audit was done for preanalytical phase (adequacy of clinical information and grossing adequacy) and analytical phase [turnaround time (TAT) and tissue section quality]. Statistical Analysis: Qualitative data was assessed by Chi-Square test. Quantitative data was assessed using One-Way Analysis of Variance. Results: Among 3179 total cases, category I to V had 1558 (49%), 1099 (34.6%), 342 (10.8%), 124 (3.8%), and 56 (1.8%) cases, respectively. Category I had shortest TAT but maximum number of inadequately sent specimens and recuts. Category III had maximum cases with inadequate clinical history, grossing errors, additional sections, and longest TAT. Category IV had maximum cases with poor quality sections. Category V had maximum cases with inadequate demographic details and clinical investigations. BMB (114, 91.9%) was more useful than BMA for diagnosis. Mean TAT for fixed tissues and frozen tissues was 3.6 ± 1.8 days and 26.6 ± 11.2 min, respectively. Conclusions: Total 25% of annual workload was studied by an observational, manual audit. Quality indicators were achieved as per international norms despite limited resources. Remedial actions were suggested for technicians, clinicians, and pathologists to minimize errors.