The College of American Pathologists Pathology (CAP) and Laboratory Quality Center in association with the Association of Directors of Anatomic and Surgical Pathology (ADASP) recently put out a new guideline to improve laboratory testing. This evidence based guideline, “Interpretive Diagnostic Error Reduction in Surgical Pathology and Cytology,” is meant to provide recommendations for systematic and timely secondary reviews of surgical pathology and cytology cases which will promote accurate diagnosis and improved patient care.
Diagnostic discrepancies have been detected through additional reviews of diagnostic surgical and cytology cases. It is in this context that that this new guideline was released with the aim to develop recommendations for the review of pathology cases through a systematic review of the literature.
Published online in the Archives of Pathology & Laboratory Medicine, the guideline is meant to help pathologists detect or prevent interpretive diagnostic errors. Implementing the guideline is expected to ensure optimal testing conditions and detect disagreements implementation, thereby improving the quality of patient care.
The main recommendations for pathologists are as follows
- Develop procedures for the review of selected pathology cases to detect disagreements and potential interpretive errors
- Perform case reviews in a timely manner to avoid having a negative impact on patient care
- Have documented case review procedures that are relevant to the practice setting
- Continuously monitor and document the results of case reviews
- Take steps to improve agreement if pathology case reviews show poor agreement within a defined case type
The expert panel also recommends that medical examiners should develop procedures for the review of cases to detect disagreements and potential interpretive errors in order to improve the quality of patient care.
Stringent quality control in the laboratory can reduce errors in results and improve lab efficiency to a great extent. According to CAP, a laboratory should have policies and procedures to ensure quality laboratory testing and patient safety. The requirements include, but are not limited to, validation of test systems, analytic quality control, quality management of pre- and post-analytic processes, proficiency testing, human resource management, on-going quality improvement, and appropriate communication to clinicians, patients, administration, and government entities. CAP recommends that for accreditation, the laboratory director should oversee a program that monitors, ensures, and documents the proper calibration, function, and maintenance of instruments and laboratory equipment.