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Root cause analysis of pre-microscopic errors in anatomical pathology using Eindhoven classification
Fakeha Rehman1, Muhammad Saqlain Haider2, Rakhshindah Bajwa3
1Pathology Department, King Edward Medical University Lahore.
Objective:
To evaluate pre-microscopic errors in anatomical pathology.
Methods:
The cross-sectional descriptive study was conducted at the Department of Pathology of a tertiary care hospital in Lahore, Pakistan, from September, 2016, to January, 2017, and comprised surgical pathology specimens. Errors were noted across the pre-microscopic process. Defects per million opportunities were calculated to determine sigma metric value in every step, from requisition to slide preparation. Root cause analysis was applied to the process of histology preparation to identify the root cause of each previously identified problem using Eindhoven classification. All errors were recorded on a pre-designed proforma.
Results:
There were 2420 specimens. While errors were encountered in all phases of the pre-microscopic process, but the (G6: n=1085, 44.83%), followed by requisition (R3: n=893, 36.9%) and cover slipping (C1: n=776, 32.06%).
Conclusions:
Development of standard procedures and protocols with staff training is likely to help in controlling the errors.
Insights
Pre-microscopic errors in anatomical pathology, particularly in grossing and requisition, were identified. Implementing standard procedures and staff training can help control these common pathology errors.
Area of Science:
- Anatomical Pathology
- Medical Laboratory Science
- Histopathology
Background:
- Pre-microscopic errors significantly impact diagnostic accuracy in anatomical pathology.
- Identifying and quantifying these errors is crucial for quality improvement initiatives.
Purpose of the Study:
- To evaluate the types and frequency of pre-microscopic errors in surgical pathology specimens.
- To determine the sigma metric value for each step in the pre-microscopic process.
Main Methods:
- A cross-sectional descriptive study was conducted on surgical pathology specimens.
- Errors were documented from specimen arrival to slide preparation.
- Root cause analysis and Defects per Million Opportunities (DPMO) were used to assess error rates.
Main Results:
- Errors occurred in all pre-microscopic phases, with grossing (44.83%) and requisition (36.9%) being the most affected.
- Cover slipping also showed a significant error rate (32.06%).
- Sigma metric values indicated areas for improvement across the workflow.
Conclusions:
- Standardized procedures and protocols are essential for error reduction.
- Comprehensive staff training is vital for improving the pre-microscopic workflow.
- Addressing errors in grossing and requisition can enhance overall pathology quality.
