 |
|
|||
   |
|||
  |
|||
 |
|||
All About HistoQIPWhat is HistoQIP?
HistoQIP is a quality assurance program for histopathology, jointly sponsored by the National Society for Histotechnology and the College of American Pathologists. The primary emphasis of the program is to improve the quality of histologic preparations routinely performed in the histology laboratory through education. The program consists of two challenges per year that include two H & E stained slides and two special stained slides on specified tissue samples. The samples should be recuts or stains from the routine work of each particular laboratory. Examples of what was requested for 2004 are uterus, colon, bone marrow and liver as well as elastin, reticulin, Helicobacter (non-silver, non-immuno) and amyloid special stains. New for 2005 is the inclusion of an immunoperoxidase challenge. Many laboratories have requested this challenge because it evaluates the technical component of performing the test. Routine preparations are requested to evaluate the slides that are being produced daily in busy laboratories. Unlike other surveys, HistoQIP is asking laboratories to submit slides from the routine day to day work, and benchmarking each laboratory against all other laboratories. Targeting histotechnologists is what makes this program unique. A panel of histotechnologists and pathologists evaluate the slides. A numeric score is given to each slide assessing the fixation, processing, embedding, microtomy, staining and coverslipping. The HistoQIP Committee has developed standardized grading criteria for the evaluation of each process scored. Committee members attend an orientation session where the criteria are discussed and illustrated, thereby reducing variation and ensuring consistency in identifying artifacts. These quality assurance measures have helped make the evaluation process as uniform and as fair as possible. The participants in HistoQIP are from varied backgrounds: hospitals, industry, and veterinary laboratories. The work load from these institutions have annual tissue block volumes ranging from less than eight hundred (800) to over one million (1,000,000). Participants’ scores are benchmarked against all the other laboratories. Currently, there are approximately seven hundred and fifty (750) participants in the program. Each participating laboratory receives a critique after a survey that consists of:• Individual evaluation: a breakdown of each step in the process, providing the score determined for your laboratory’s slide, comments about defects or excellence of the slide, the mean, median and standard deviation, and a graph which shows your lab’s performance on each particular challenge as it relates to the other participants. • Evaluator’s commentary: focus on a particular problem that is identified during grading. In 2004, many institutions had problems with the bone marrow challenge. A commentary was written identifying problems and possible solutions that could be used by the laboratories. • Characteristics of best performers: commentary regarding best practices or procedures that contribute to a laboratory’s superior slide quality. A table identifying specific parameters is included. • Observations about the survey: demographics providing information about equipment, techniques used, and stain preparation. • Spotlight on practice: an in-depth discussion of problems such as microtomy or fixation and processing. Spotlights include information about the specific tissue requested for the survey, such as: the microanatomy of the bone marrow; what the pathologist is likely looking for on the H & E slide; what the histologist needs to produce on the H & E slide so the pathologist can make a diagnosis; digital pictures or photomicrographs that support the information discussed; and references for further investigation. • Special stain discussion: each stain is discussed, including the application or disease process, principle of the stain, technique variations, safety, problem solving, photomicrographs or pictures, sheets and references. The Committee has been adamant that educational materials need to be developed for each challenge so the histologist in the laboratory has a reference on how to improve the quality of their slides. Each educational piece is written either by a knowledgeable histotechnologist, pathologist or a consortium of the Committee. Information returned to the participants is being used in different ways. Many laboratories evaluate their deficiencies, look at the best performer techniques and implement procedures to improve their quality. Other laboratories use the educational materials for in-services for their employees. The materials foster discussion about a particular stain or tissue. The in-depth discussions are very useful for those individuals who need a refresher or for those who are gaining knowledge to take a particular registry examination. Several laboratories have noted that the challenges are being used for proficiency testing, since objective Committee members have evaluated the slides. Proficiency testing is a requirement for laboratory accreditation by outside accrediting agencies. For those laboratories that are consistent “best performers”, this evaluation is providing documentation and evaluation that reinforces the excellence of their histologic preparations. If a laboratory is looking for new equipment, the demographic material provides information about what the participating laboratories are using. There are questions on the survey that ask about everything from the type of processor and embedding paraffin to the types of blades being used. Beginning in 2005, the opportunity to gain continuing education (CE) credit for participation in the program became available. CE Credit consists of a short on-line exam with questions from the educational materials from the challenge. The program continues to grow and evolve. For example, an atlas of the most common artifacts and problems is being developed utilizing illustrations and commentary. The Committee continues to look at ways to improve the program and provide meaningful educational materials to the histology community. Our mission as a Society is to provide education for our members. We hope that HistoQIP will grow and continue to offer much needed information to help us improve our practice of providing quality care to our patients. Click Here for the HISTOQIP/CAP publication Histologic Preparations Click Here for Information on HistoQIP On-Line Continuing Education Opportunity By Lena Spencer, NSH Member Since 1976 For more information on HistoQIP, or to place an order, call CAP at 800-323-4040, option 1. |
