November 1, 2016
These recommendations from 2016 aim to enhance patient safety through better and more consistent quality assurance in pathology across Canada
This document’s framework of recommendations relates to the interpretive, or medical consultative part of pathology. The recommendations mainly apply to surgical pathology including contemporary ancillary techniques, like immunohistochemistry and molecular pathology. These recommendations also apply to other subspecialty areas, like cytopathology and morphologic hematology (blood films, bone marrows). However, those latter specialties also have specific QA measures which are recommended through their respective specialty societies and provincial accreditation bodies.
Although this framework applies to the practice of pathology, there may be additional nuances not covered which need to be taken into consideration when addressing highly specialized practices like pediatric pathology, neuropathology and hematopathology.
This document first deals with the overarching foundational elements that need to be in place to support a quality system for interpretive pathology. Detailed parts of the pathology testing cycle are considered from the practicing pathologist’s perspective. Then, this document has a section about the internal Quality Assurance Policies and Procedures (QAPP) that need to be in place to assure interpretive QA. Next, external quality assurance measures, like proficiency testing and pathologists’ peer reviews are covered. Finally, the document gives a recommendation regarding an “expression of concern” raised about a pathologist’s performance.
This report does not specifically address that implementing these recommendations will require considerable human, physical and technical resources. Nor does this report advocate for those resources. Instead, these recommendations are meant to give guidance and help steer away from a Blame and Shame approach. The recommendations should be contextualized based on the characteristics of local health systems.
Watch Dr. John Srigley and Dr. Victor Tron discuss these quality assurance recommendations
The Quality Initiative for Interpretative Pathology (QIIP) began in 2013, when the Partnership and the Canadian Association of Pathologists (CAP-ACP) came together to improve the quality of interpretive pathology in Canada.
QIIP released these recommendations in 2016. The recommendations framework is the first of its kind in Canada. The framework helps jurisdictions incorporate the recommendations into both new and existing programs about quality.