International Journal of Medical Laboratory Research (IJMLR)

AUDIT IN SURGICAL HISTOPATHOLOGY: STUDY OF PREANALYTICAL AND ANALYTICAL PHASES

 

Kiran Agarwal, Smita Singh, Neha Suman

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ABSTRACT: An audit provides information about the conformance to required standards, assesses their implementation, and provides corrective actions to improve quality. Surgical histopathology includes biopsy, small and large organ resections. Audit of a surgical histopathology laboratory allows improving the overall performance and better patient care. Aims: To evaluate preanalytic and analytic phases of surgical histopathology. Materials and methods: Biopsy, small resections and large organ resections received in histopathology were categorized as I, II and III, respectively. A manual audit was done for the preanalytic phase (patient details, adequacy of clinical information, specimen and grossing adequacy) and analytic phase (tissue section quality, special stains, immunohistochemistry and turnaround time (TAT). Results: Among 540 total cases, category I, II and III had 56.8%, 29.8% and 13.3% cases, respectively. Category I had maximum number of cases with inadequate clinical details and specimen inadequacy, however shortest TAT was seen in most of these cases. Category II had maximum cases with inadequate grossing followed by category III. Longest TAT was observed in category III. Conclusions: The present study was a manual audit and most of the quality indicators were achieved in accordance with the international standards. Corrective actions were suggested to further improve the quality and better patient care. 

KEYWORD:  Audit, quality, surgical histopathology, turnaround time

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REFERENCES:

1. [1]. Omorodion NT, Achukwu PU, Ebo N. Review on laboratory auditing in histopathology laboratory. Sokoto J Med Lab Sci 2017; 2:124-8.

2. [2]. Iyengar JN. Quality control in the histopathology laboratory: An overview with stress on the need for a structured national external quality assessment scheme. Indian J Pathol Microbiol 2009; 52:1-5.

3. [3]. Zuk JA, Kenyon WE, Myskow MW. Audit in histopathology- Description of internal quality assessment scheme with analysis of results. J Clin Pathol 1991; 44:10-6.

4. [4]. Karki S. Errors: Detection and minimization in histopathology laboratories. J Pathol Nepal 2015;5: 859-64.

5. [5]. Shinde SV, Dhanve MJ. Audit in surgical histopathology at a tertiary healthcare center: Study of preanalytical andanalytical phase. Indian J Pathol Microbiol 2021; 64: 136-9.

6. [6]. Nwafor CC, Ekpo MD. Timeliness of surgical pathology results: A departmental audit of histopathological services. Sub-Saharan Afr J Med 2019; 6:96-100.

7. [7]. Priyadharisini, Porko S, Barman PP. Audit of histopathology request forms submitted in laboratory of a tertiary care hospital. J Med Sci Clin Res 2019; 7:1085-9.

8. [8]. Sirota RL. Error and error reduction in pathology. Arch Pathol Lab Med 2005;129: 1228–3.

9. [9]. Akinfenwa TA, Raphael S. Role of surgeons in determining outcome of histopathology specimens. Niger J Surg 2013; 19: 68-72.

10. [10]. Bhattacharya AB, Bohara S, Das R, Sharma P, Vidyadhar S. An audit of diagnostic surgical pathology: A tool forquality assurance. Original study in a rural teaching hospital in Eastern Uttar Pradesh, India. J Dent Med Sci 2015; 14:32-3.

11. [11]. Nakhleh R, Coffin C, Cooper K. Association of Directors of Anatomic and Surgical Pathology. Recommendations for quality assurance and improvement in surgical and autopsy pathology. Am J Surg Pathol 2006; 126:334-7..

12. [12]. CAP QCDR MEASURES ID/CMS QCDR ID-22. Measure title: Turnaround time biopsies

13. [13]. Volmar KE, Idowu MO, Souers RJ, Karcher DS, Nakhleh RE. Turnaround time for large or complex specimens insurgical pathology. A college of American pathologists Q-Probes study of 56 institutions. Arch Pathol Lab Med. 2015; 139:171-7.

14. [14]. Malami SA, Iliyasu Y. Local audit of diagnostic surgical pathology as a tool for quality assurance. Niger J Med2008; 17: 186-90.