A Novel Daily Quality Assurance/Quality Control (QA/QC) Program Based on the National Society for Histotechnology/College of American Pathologists (NSH/CAP) HistoQIP Program
P Aoun, K Zeitner, JM Gerriets, DE Muirhead. University of Nebraska Medical Center, Omaha, NE; The Nebraska Medical Center, Omaha, NE
Background: Criteria for measuring the quality of histological preparations on a routine basis are typically developed internally and lack standardization. The NSH/CAP HistoQIP Program is designed to evaluate slides according to standardized criteria, providing peer comparison and benchmarking data, but is available only twice yearly. The goal of this study was to evaluate the feasibility and impact of implementing a daily slide QA/QC program based on the HistoQIP standardized criteria.
Design: Criteria for grading the quality of the fixation, processing, embedding, microtomy, and staining were developed based on published reports from the HistoQIP Program. During a 3 month pilot program, H&E slides were reviewed daily by randomly selecting 1 slide from each rack of 20 slides (5%), and graded by a senior histotechnologist using the HistoQIP Program scoring system. Subsequently, the histology laboratory staff were educated about the new program, and the number of selected slides was increased to 2 slides from each rack of 20 (10%). For the 10% review period, data were recorded daily for 17 months, and presented to the technical staff monthly and to the pathologists quarterly.
Results: A total of 19,690 of 209,380 slides were reviewed. Deficiencies were present in 10.8% of all reviewed slides and were primarily in microtomy (84.8%), followed by embedding (6.4%), fixation (4%), processing (2.8%), and staining (2%). Microtomy deficiencies included folds/wrinkles (49.1%), chatter (8.7%), extraneous epithelial cells (8.6%), knife lines (6.8%), incomplete sections (6%), loose tissue (3%), floaters (1.5%), and inproper section thickness (1.3%). As a result of monitoring, targeted interventions were implemented during the study period, resulting in a decrease in the number of deficiencies from an average of 21% (range 20.4-22.1%) during the pilot program to an average of 10.1% (range 6-15.6%) during the study period. Improvements in quality of non-reviewed slides, staff attention to detail, and documentation of problems encountered during embedding and cutting were also noted by laboratory management.
Conclusions: The NSH/CAP HistoQIP Program criteria for evaluation of the quality of histological preparations can provide a basis for a standardized daily QA/QC program that is easily implemented and that can be used to develop performance indicators for monitoring and improving quality.
Category: Quality Assurance
Monday, March 22, 2010 1:00 PM
Poster Session II # 208, Monday Afternoon