[Histonet] Re: Quality Assurance for Histology

[Robert Richmond]

Quality Assurance for Histology: I've been a locum tenens pathologist
for nearly 30 years, and have worked on more than 60 pathology
services in my "career". I'll make some melancholy observations on
this subject.

The more "quality assurance" paperwork I have to do, the worse the
quality of the slides.

I always get a lot of angry response when I say this on Histonet, but
I assure you that the great majority of small pathology service
histotechs take great pride in not having a microscope and never
looking at a slide.

The most common problems I see are excessive variability of staining,
and venetian-blind artifact in Gi biopsy sections. (I don't see
problems with inadequate processing, because I don't overload
cassettes and I insist on adequate time for fixation.)

If I ran the zoo, I would want to review some selected slides with a
senior histotech at the end of every day, using a double-headed
microscope. Some written record would need to be generated, I imagine.
I have NEVER seen this sort of review done.

Pathologists bear the ultimate responsibility for solving these
problems. Residency programs have been completely ineffective in
training pathologists how to do this.

I wish I knew more about how radiology services do quality assurance.
I notice that I don't see out-of-focus X-ray films.

The MBA's drove Edwards Deming to Japan more than half a century ago
rather than adopt it, but effective feedback is necessary in any
manufacturing process.

Bob Richmond
Samurai Pathologist
Knoxville TN