[Internal quality control of histological diagnosis in pathology. A nine-year experience].
Internal quality control (IQC) is a necessary component of total quality management. We report our experience with an internal audit scheme focusing on the histological diagnosis. We outline other strategies of IQC and analyze the causes of errors and ways to prevent them. Some practical guidelines to initiate this type of procedure are presented. Our audit was designed to check the accuracy of diagnosis, the clarity and completeness of the report, the quality of the documents leading to the diagnosis, and the turn-around time. It consisted of a retrospective analysis of 4185 randomly selected cases (representing 2% of all cases), over nine years. The control took place once a week and was done by two pathologists working as a team. The mean time spent by each pathologist was 45 minutes per week. Errors were scored using a 3-level grading scheme depending on their potential harm or impact on patient care. The overall rate of errors was 1.1%, and 0.1% of errors were potentially harmful to the patients. A single case (0.02%), in which a cancer was missed, had a real impact on patient care. Retrospective analysis of randomly selected cases mirrors the overall activity of a surgical pathology department. Nevertheless, each lab has to develop its own strategy of IQC, based on its size, its functioning, and its objectives. Although it may be difficult to initiate quality assurance when medical time is already limited, it is a helpful procedure in a more and more demanding medical and societal context and a pragmatic step towards "culture of quality".
Croce-Kleinmann
Sabrina
S
Département de pathologie, hôpital de Hautepierre, CHU de Strasbourg, 1, avenue Molière, 67098 Strasbourg cedex, France.
Marcellin
Luc
L
Neuville
Agnès
A
Onéa
Alina
A
Lindner
Véronique
V
Casnedi
Selenia
S
Lhermitte
Benoît
B
Avérous
Gerlinde
G
Walter
Paul
P
Bellocq
Jean-Pierre
JP
Chenard
Marie-Pierre
MP
D000715:Anatomy / Q000592:standards*; D003933:Diagnosis; D003951:Diagnostic Errors / Q000706:statistics & numerical data; D004282:Documentation / Q000592:standards; D006801:Humans; D009369:Neoplasms / Q000473:pathology* / Q000601:surgery*; D010336:Pathology / Q000592:standards*; D018024:Peer Review, Health Care; D017410:Practice Guidelines as Topic; D011786:Quality Control