MP16-03 STRATEGIC IMPROVEMENT IN PROSTATE BIOPSY FIXATION; ROLE OF INTERDISCIPLINARY QUALITY COLLABORATION IN UROLOGIC PRACTICE

Abstract

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Cost Effectiveness I1 Apr 2015MP16-03 STRATEGIC IMPROVEMENT IN PROSTATE BIOPSY FIXATION; ROLE OF INTERDISCIPLINARY QUALITY COLLABORATION IN UROLOGIC PRACTICE Ashley Winter, Paul DiMaggio, and Brian Robinson Ashley WinterAshley Winter More articles by this author , Paul DiMaggioPaul DiMaggio More articles by this author , and Brian RobinsonBrian Robinson More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.810AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Improperly fixed prostate needle-core biopsy specimens (PNCBS) may suffer artifactual histologic changes that obscure accurate diagnosis and affect patient safety. Given the direct impact on cost and clinical decision-making, tissue fixation is considered a basic quality measure. A collaborative root cause analysis was undertaken with the Department of Pathology via an institutional, resident-led house-staff quality council (HQC), in order to eliminate receipt of improperly fixed PNCBS. METHODS Hematoxylin and eosin (H&E) stained slides of all consecutive PNCBS received during a randomly selected month were reviewed by two pathologists. Each biopsy was assessed for histologic artifacts of poor preservation including: 1) nuclear smudging and “halo” formation; 2) cytoplasmic vacuoles; 3) stromal cracking/retraction; and 4) lack of hyperchromasia and nucleoli in prostatic carcinoma. PNCBS with at least one artifact were considered poorly fixed, those lacking artifacts were considered adequately fixed. Poor fixation was noted to originate at a single center (Site 1). HQC representatives reviewed standard operating procedures (SOP) in all practices to identify differences between the adequately and poorly fixed practices. RESULTS 42 consecutive PNCBS were reviewed prior to intervention. HQC analysis revealed that PNCBS at Site 1 were being placed in sterile water prior to formalin fixation. SOP was immediately changed to utilize normal saline. 31 consecutive biopsies were then prospectively reviewed in a blinded fashion. Percentage of specimens from Site 1 with adequate fixation improved significantly following implementation of normal saline use (18.2% pre- vs 100% post- intervention, respectively p< 0.0001). CONCLUSIONS Collaboration via the HQC facilitated identification of a significant problem, and lead to dramatic and rapid improvement in PNCBS fixation. Resident-led quality assurance committees within hospitals can serve as a model for interdepartmental collaboration in resolving QA/QC problems while facilitating resident education. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e168-e169 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ashley Winter More articles by this author Paul DiMaggio More articles by this author Brian Robinson More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...