Improving patient safety through quality assurance.

CONTEXT

Anatomic pathology laboratories use several quality assurance tools to detect errors and to improve patient safety.

OBJECTIVE

To review some of the anatomic pathology laboratory patient safety quality assurance practices.

DESIGN

Different standards and measures in anatomic pathology quality assurance and patient safety were reviewed.

MAIN OUTCOME MEASURES

Frequency of anatomic pathology laboratory error, variability in the use of specific quality assurance practices, and use of data for error reduction initiatives.

RESULTS

Anatomic pathology error frequencies vary according to the detection method used. Based on secondary review, a College of American Pathologists Q-Probes study showed that the mean laboratory error frequency was 6.7%. A College of American Pathologists Q-Tracks study measuring frozen section discrepancy found that laboratories improved the longer they monitored and shared data. There is a lack of standardization across laboratories even for governmentally mandated quality assurance practices, such as cytologic-histologic correlation. The National Institutes of Health funded a consortium of laboratories to benchmark laboratory error frequencies, perform root cause analysis, and design error reduction initiatives, using quality assurance data. Based on the cytologic-histologic correlation process, these laboratories found an aggregate nongynecologic error frequency of 10.8%. Based on gynecologic error data, the laboratory at my institution used Toyota production system processes to lower gynecologic error frequencies and to improve Papanicolaou test metrics.

CONCLUSION

Laboratory quality assurance practices have been used to track error rates, and laboratories are starting to use these data for error reduction initiatives.