[Histonet] Re: Basis for Quality Work in a Histotech

Thu Dec 20 14:08:37 CST 2012

I really appreciate this conversation because it show's an interaction
between different members of the team.  I sometimes think people forget that
there are other team members besides just the histotechnologists or just the
pathologists or just the pathology assistants, etc., etc.

The only other point I'd like to add from an LIS vendor perspective is that
the next time you purchase an LIS or a tracking system, or some other
computerized solution, that's the time you want to use to ensure that it's
easy to log quality or other 'actionable' issues  and that those same
indicators are easily available to ALL team members.

As others have said, quality has to be part of the process.  In order to
increase the likelihood of a system's use, it needs to be easy to use and
communicate.

If it takes too many sheets of paper, too much time, or if it's just a
painful process where no one sees any benefit, then it's doomed to a very
uphill battle.

Michael Mihalik
PathView Systems | cell: 214.733.7688 | 800.798.3540 | fax: 952.241.7369

-----Original Message-----
From: histonet-bounces <@t> lists.utsouthwestern.edu
[mailto:histonet-bounces <@t> lists.utsouthwestern.edu] On Behalf Of Morken,
Timothy
Sent: Thursday, December 20, 2012 11:21 AM
To: Lynette Pavelich; Bob Richmond; histonet <@t> lists.utsouthwestern.edu
Subject: RE: [Histonet] Re: Basis for Quality Work in a Histotech

We have a QC sheet but it is only used when the pathologist/resident sees
something out of whack. We don't QC every single slide or even case.
Remember also that someone has to review all those forms or it's a waste of
time so the fewer the better! 

The result is we have about one QC sheet every other day (1500 hundred
slides/day between H&E, IHC and SS). Fully half are submitted by one
pathologist. That pathologist is also the ONLY one who submits them for good
as well as poor slides (though in about a 10:1 ration bad:good). 

I keep track of them on a spreadsheet and do a review with the tech involved
(f there is one). It is pretty random as to which techs have "errors,"  and
all have at least one during a year's time, but we have picked up a few
sectioning and stain problem trends over the years. It seems to work ok and
it does not seem to be a burden. 

I also talk regularly with individual pathologists and just randomly ask
them if they have seen any problems they want me to work on.  I pick up a
few issues that way.

Of course if it is something they feel is really a problem I get the phone
call...

Tim Morken
Department of Pathology
UC San Francisco Medical Center

-----Original Message-----
From: histonet-bounces <@t> lists.utsouthwestern.edu
[mailto:histonet-bounces <@t> lists.utsouthwestern.edu] On Behalf Of Lynette
Pavelich
Sent: Thursday, December 20, 2012 11:06 AM
To: Bob Richmond; histonet <@t> lists.utsouthwestern.edu
Subject: RE: [Histonet] Re: Basis for Quality Work in a Histotech

Dr. Richmond,
It's always refreshing to hear what the "other shoe" has to say! I'm sure
seeing those required quality control sheets coming in everyday is tiring,
and then especially frustrating when small to none results are seen in a
timely manner. I can empathize with you as change/improvement can sometimes
take a long time!! 

I also realize.......after being in the field 40+ years (ouch!), that verbal
communication seems to work faster than all those required sheets of paper
you have to fill out. Like the pathologist who comes through the door
saying; "HEY.......what happened with this slide??" (LOL) will get a much
faster response/correction than those papers I receive back everyday to
collate! It's just more personal, and shows the techs more of the
pathologist's side of the hardships of diagnosing after receiving less than
lovely slides.

Equally refreshing, is a pathologist who remembers to thank the tech who
does a great job! And I thank you for that! A genuine complement is really
appreciated!

Lynette

Lynette Pavelich, HT(ASCP)
Histology Supervisor
Hurley Medical Center
One Hurley Plaza
Flint, MI 48503

ph: 810.262.9948
mobile: 810.444.7966

________________________________________
From: histonet-bounces <@t> lists.utsouthwestern.edu
[histonet-bounces <@t> lists.utsouthwestern.edu] on behalf of Bob Richmond
[rsrichmond <@t> gmail.com]
Sent: Thursday, December 20, 2012 1:42 PM
To: histonet <@t> lists.utsouthwestern.edu
Subject: [Histonet] Re: Basis for Quality Work in a Histotech

From: Kim Donadio <one_angel_secret <@t> yahoo.com>
Subject: Re: [Histonet] Basis for Quality Work in a Histotech
To: "O'Donnell, Bill" <billodonnell <@t> catholichealth.net>,        Maria Mejia
        <mbmphoto <@t> gmail.com>,   "Morken, Timothy"
        <Timothy.Morken <@t> ucsfmedctr.org>
Cc: "histonet <@t> lists.utsouthwestern.edu"
        <histonet <@t> lists.utsouthwestern.edu>
Message-ID:
        <1355948250.57406.YahooMailNeo <@t> web112302.mail.gq1.yahoo.com>
Content-Type: text/plain; charset=utf-8

Kim Donadio (where?) comments:
>>I'd like to add my two cents to the measuring "Quality" topic. I'll 
>>make it short. - You should have a "Quality Management" program. It's 
>>vital to track errors, types of errors, frequency and who etc. This is 
>>NOT a tool for blame as we are all adults or we should be. It is 
>>however a tool for tracking trends, making improvements and yes if you 
>>did see someone making a mistake often, you would have the data to 
>>educate particular personnel. - There are QM tools out there from 
>>various organizations. And yes, there are standards of deviations such 
>>as the TAT for frozens. There are standards for other things as well.
>>Set Standards of excellence with your Pathologist. Make goals. Track 
>>them. Follow improvement.<<

I'm going to add a sour and cynical rejoinder. As most of you know, I'm an
elderly pathologist who's spent the last 30 years as a locum tenens, working
maybe 60 pathology services in my "career". Sometimes in a pathology
practice I'll be asked to fill out daily "quality whatever" (the patter
changes with the years) reports about the slides. I always dread having to
do this, because I know that the more of this paperwork I have to do, the
worse the slides will be. The worst was one that required several square
inches of scribbling a day.
They couldn't mount a coverslip correctly.

Any meaningful system would require daily feedback from pathologist (or
other end user) to histotechnologist. I've never encountered a pathology
service that accomplished this.

Dang - now I'm remembering that this morning duodenal biopsy sections were
the best I'd ever seen here, and I forgot to tell the histotech before she
slipped out the door!

Bob Richmond
Samurai Pathologist
Maryville TN

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