New recommendations seek to improve the quality of pathology practice

On International Pathology Day, the Canadian Partnership Against Cancer is releasing recommendations to improve the quality of interpretive pathology practice in Canada. The Pan-Canadian Quality Assurance Recommendations aim to enhance patient safety by promoting better and more consistent pathology quality assurance processes across the country. Developed in partnership with the Canadian Association of Pathologists – Association canadienne des pathologistes (CAP-ACP), the framework is an informational and decision-making resource to guide and support individual jurisdictions in incorporating recommendations into new and existing quality programs.

Pathologists are medical specialists who analyze cells and tissues removed via biopsies and surgical resections. They use a variety of techniques including genetic ones to generate key information required for diagnosis, prognosis, treatment planning, for cancer and other conditions, which can be used to predict a person’s likely response to therapy. The pathologist in essence is the cancer patient’s diagnostic oncologist.

“Pathology leaders across the country recognized that there were gaps in quality assurance activities as it relates to the practice of pathology,” said Dr. John Srigley, Expert Lead in Pathology at the Partnership.

While the technical and administrative processes performed by laboratory staff are well regulated and accredited, quality systems governing the medical practice of pathology are less well developed and not standardized across the country. For these reasons, there was a growing interest at the provincial, national and international levels, in developing a more standardized approach to quality assurance in interpretive pathology.

“The framework is an outcome of national consensus-based efforts to enhance performance in pathological diagnoses, quality of care and patient safety,” said Dr. Srigley.

Provinces are at various stages of planning and implementation of quality assurance programs, with several working to develop programs in the near future. Currently, a few provinces such as Alberta, Ontario and Prince Edward Island have coordinated provincial-level quality assurance programs that relate to interpretive aspects of pathology.

The recommendations created will help to guide the development of these programs by providing a minimum set of recommendations that can be adapted and contextualized according to the local health system characteristics.

Dr. Victor Tron, President of CAP-ACP commended the document, calling it “a great step forward in high quality and safe pathological diagnosis for patients across the country.”

This is Canada’s first effort to develop a framework of quality recommendations for interpretive pathology that can be implemented into existing and developing provincial pathology quality assurance programs.

The framework includes:

• Foundational elements that need to be in place to support a quality system for interpretive pathology;
• Internal Quality Assurance Policies and Procedures (QAPP) that need to be in place to assure interpretive quality assurance;
• A section on the pathology testing cycle’s interpretive phase from the prospective lens
• External quality assurance in the form of either external quality assessment (proficiency testing) and pathologists’ peer review assessment;
• Recommended approaches to situations where there has been an “expression of concern” regarding a pathologist’s performance.

Ultimately, these recommendations can be used by pathology leaders and other senior decision makers to develop standards and guidelines for interpretive quality assurance and improvement programs within provinces where they are underdeveloped or emerging.

International recognition

The Pan-Canadian Quality Assurance Recommendations were recognized by international pathology leaders:

The College of American Pathologists Pathology and  Laboratory Quality Center

“I congratulate the Canadian Partnership Against Cancer and its leaders for developing and releasing their Pan-Canadian Quality Assurance Recommendations for Interpretive Pathology. This is a vigorous and comprehensive document that serves as a great platform for institutions to develop their own programs in achieving high quality interpretive diagnostic pathology.”

—Raouf E. Nakhleh MD, Committee Chair

Royal College of Pathologists, United Kingdom

“The Specialty Advisory Committee for Cellular Pathology for the Royal College of Pathologists congratulates CAP-ACP and CPAC on a comprehensive document covering all important aspects of the work of histopathologists and cytopathologists. Members particularly liked the fact that arrangements for assuring quality in other countries were reviewed. One member expressed an aspiration that in the future there might be international co-operation in developing quality standards. In summary, we found this to be an excellent, clear and comprehensive document.”

—Dr. Anne Thorpe, Chairman of Specialty Advisory Committee for Cellular Pathology

The Royal College of Pathologists of Australasia

“The Royal College of Pathologists of Australasia congratulates the Canadian Partnership Against Cancer and the Canadian Association of Pathologists on the launch of the Pan-Canadian Quality Assurance Recommendations which are an excellent over-arching blueprint for the high quality practice of interpretative pathology, a cornerstone of medicine.”

—Dr. Michael Harrison, President

Royal College of Physicians of Ireland

“Overall the Canadian Quality Initiative in Interpretive Pathology (QIIP) approach is very similar to the Irish Faculty of Pathology QI program approach which is building an internationally respected track record. The document is to be commended for clarity, particularly considering complexity of issues involved.”

—Histopathology National Quality Improvement Programme Working Group, RCPI Programme Team