Quality Indicators for Error Minimisation in Histopathology: Experience at a Tertiary Care Centre

Abstract

Introduction: Quality Indicators (QI) are parameters defined by Quality Management System (QMS) in a laboratory to assess and monitor quality of results generated. A regular and periodic review of these QI also help improves the quality of laboratory results. These QI are often under-utilised or less commonly followed-up in histopathology laboratory/Surgical Pathology. Aim: This study was conducted with the aim to evaluate QI and their role in improving the quality in histopathology. Materials and Methods: This cross-sectional study was conducted in histopathology laboratory of a Tertiary Care Hospital and Teaching Institute located in Dehradun, Uttarakhand, India from January, 2016 to June, 2018. A set of nine QI were evaluated biannually and the data was analysed using ANOVA test followed by Post-hoc Tukey’s test. Results: During the study period, number of unacceptable samples (QI-1) was zero. Number of errors at registration and/or accession (QI-2) was five (0.05% with respect to total number of specimens). Completeness of equipment (QI-3) and performance in External Quality Assurance Programs (EQAP) (QI-4) were satisfactory throughout. Number of amended reports (QI-5) were three (0.03%). There were two (0.02%) complaints/negative feedbacks from users (QI-7). QI-8 (laboratory safety and environment) and QI-9 (effectiveness of document control system) were maintained during the study period. Turn Around Time (TAT) (QI-6) as a QI which was deranged mostly (4.5%). Reasons for delayed TAT were further analysed. It was found that pre-analytical factors were the common and statistically significant reasons behind the delayed TAT as compared to analytical and post-analytical ones. Root cause analysis and future preventive actions were undertaken accordingly to improve the quality. Conclusion: Periodical review of QI helps in understanding the flaws in the analytic cycle and appropriate actions undertaken accordingly helps in improving the quality in histopathology.