Audit in surgical histopathology at Wadia hospitals - Study of pre-analytical, analytical, and post-analytical phase

Abstract

Objectives: This audit of surgical histopathology aims to verify conformance to required processes, assess their implementation, and define the targets of quality control with appropriate changes in the existing system by evaluating pre-analytical, analytical, and post-analytical phases of histopathology. Material and Methods: This study was an observational retrospective study done over a year, from March 15, 2022 to February 28, 2023. Small biopsies, large organ resections, and second opinion samples like paraffin blocks or slides received in the surgical histopathology department were categorized as I, II and III respectively. Samples were also segregated as per the department it was received from, namely, gastroenterology, neurology, pulmonology, nephrology, orthopedics, gynepathology, and others. Manual audit was done as a pre-analytical phase including adequacy of clinical information and grossing adequacy, analytical phase to study the turn around time (TAT) and tissue section quality, and the post-analytical phase in the form of report verification, approval and dispatch, and amendment if any, were studied. Results: During this audit period, 1752 surgical histopathology samples were received of which 80% were small biopsies (category I), 19.6% were large organ resection samples (category II) and 0.4% samples were received for second opinion (category III). General pediatrics (n = 798) and Gynepathology (n = 569) were the main departments from which the samples were received. Incomplete request forms, errors in sample fixation, wrong payment/barcode were some of the pre-analytical errors. Training of staff on one to one basis was done. In the analytical phase errors such as nicks, folds or air bubbles in the mounted sample were seen. Histotechnical staff were retrained to reduce errors. In the post analytical phase, the turnaround time was achieved as per the hospital quality process indicator, feedback from cases on second opinion was received only in 25% of samples. Conclusions: In this surgical histopathology audit of 1752 samples, quality indicators were achieved as per external quality assurance system (EQAS). Remedial actions were carried out to prevent errors.