[Histonet] H-QIP

[Rene J Buesa]

Dear Terri:
Reading your comment I became aware of your frustration, that I share. At the end your "There, I feel better now" sums up your state of mind.  Now let me try to be the Devil's advocate:
 
1- participating in the H-QIP is similar to sending a draft to a journal to be subjected to peer review. The reviewers will write their opinions and the author will address them. Some Journals wrongly think that it is the duty of the author to accept ANY and ALL comments and incorporate them into the article and that is wrong. The author has an insight on the article privy to him or her, and the reviewer sometimes has a strong opinion about something that sometimes do not coincide with that of the author's, so a "compromise" is needed.
 
2- a critique from the H-QIP is similar; the reviewers, as you point out, point out to defects and give optimal solutions. I personally agree with you that a busy laboratory does not have the "luxury" of treating all tissues "ideally" and the recommendations about the spleen are just that, optimal, but that does not mean tha you should not try improve your method.
You could set provisions to, within the actual possibilities, try to improve the ways you fix your tissue.
This is a "two ways avenue", the H-QIP reviewers also have to "get real" and you should improve, otherwise, in order not to upset you in the future, just stop sending your slides to H-QIP. I am sure that your slides are perfect "for diagnostic purposes" even if they are not "histologically perfect".
 
There, that is my comment and advise to you!
Happy New Year!
René J. 

--- On Tue, 1/6/09, Terri Braud <tbraud <@t> holyredeemer.com> wrote:

From: Terri Braud <tbraud <@t> holyredeemer.com>
Subject: [Histonet] H-QIP
To: histonet <@t> lists.utsouthwestern.edu
Date: Tuesday, January 6, 2009, 12:29 PM

I just reviewed the 2008 H-QIP B Final Critique with my staff.  For want of a
more practical discussion, their one overwhelming response was, "GET
REAL!!!"  
Case in point and I quote, "Fixation - the spleen should be weighed,
measured, sliced into thin sections, laid out, and placed into a large among of
fixative as soon as they are brought to the laboratory." 
In a busy working lab, few have the luxury of staff and time to perform the
steps necessary for the perfection of fixation and processing that these surveys
seem to desire. Also, frequently, a histotech has no input or control over the
initial fixation step. Histotechs often process a wide variety of tissues
together, and for the sake of turnaround time, not all tissues are processed
optimally, but NEVER suboptimal to the point of compromising an accurate
diagnosis. 
I see the benefit of the H-QIP discussion on how to achieve perfectly processed
and sectioned tissue, but often, the survey results and resulting followup are
forwarded to people outside of laboratory medicine.  Those outside of Lab
Medicine don't understand the subtle, qualitative difference between
"readable" and "perfect", and I, for one, would appreciate
that difference included in the Final Critique on H-QIP.
There, I feel better now.  Thank you for listening.

Terri L. Braud, HT(ASCP)
Anatomic Pathology Supervisor
Laboratory
Holy Redeemer Hospital and Medical Center
1648 Huntingdon Pike
Meadowbrook, PA 19046
(215) 938-3676 phone
(215) 938-3689 fax


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