Ensuring Quality Ensures Success

By James L. Wisecarver, MD - November 16, 2022


This year marks the tenth anniversary of Critical Values. Over the past ten years, a variety of topics have been covered within these pages. Many of these articles have addressed the importance of having high-quality, accurate diagnostic laboratory and anatomic pathology test results available in a timely manner to assist the care team. So how do we measure quality?

Quality can be defined as the standard of something as measured against something of a similar kind. In other words, the degree of excellence of something. The common jargon for measuring it in the clinical lab is “benchmarking.” One of the problems that our industry has faced over the years has been identifying exactly what benchmarks are most useful in helping define quality.

The American Society for Clinical Pathology (ASCP) announced the creation of a new program that will assist pathologists and laboratories in measuring how they compare against national quality standards. The National Pathology Quality Registry (NPQR), currently organizing for a 2018 launch and detailed in a separate article in this issue, will allow participating labs to compare their performance against peer institutions across the US and Canada. The development of this registry required months of input from multiple teams of experienced pathologists and laboratory professionals. These teams identified an initial set of reporting measures covering all aspects of the testing process, ranging from preanalytic problems to postanalytic reporting.

This registry also provides a means for pathologists to capture the information necessary to qualify for the Centers for Medicare and Medicaid Services Merit-Based Incentive Payment System.

As we all know, quality is a moving target. As laboratories continue to strive to improve quality, the standards will change. Consequently future work teams will continue to expand and improve on these measurements. This will allow participants to monitor their performance and identify ways to improve their operations, which will provide a dynamic process to improve clinical laboratory quality in the years ahead.

Another critical component for providing quality and timely test results is the availability of a highly skilled workforce. The ASCP Board of Certification (BOC) is considered the global “gold standard” for certifying the laboratory personnel that staff today’s advanced laboratories. The rapid pace of technological advancement of test systems and instrumentation requires equally rapid updating of curriculum and examination materials. In addition, given the average age of the current lab workforce, replacing experienced lab staff members as they enter retirement will be an ongoing challenge, as discussed in this publication several times over the past ten years. The BOC has helped the industry track these workforce trends through its biannual Wage and Vacancy Survey. This survey continues to provide data that can be used as a tool by program directors and others as they try to recruit talented young people to the profession.

In addition to helping educate and certify lab professionals, educating the future pathologist workforce is equally important. The ASCP Resident In-Service Examination, or RISE, continues to provide residents with an assessment of how their performance compares to that of their peers. Pathology residency program directors also use this important quality benchmarking process to measure how effectively their program prepares their trainees for future practice. Additional tools to measure the performance of trainees in their fellowship years are now also becoming available.

One often overlooked, but arguably the most important quality program that the laboratory team provides is the autopsy. This procedure offers physicians and hospitals an extremely valuable tool for monitoring the care they provide for their patients. The postmortem examination has repeatedly been shown to be an effective tool for identifying disease processes and care issues that may have gone unnoticed by the clinical team during life. Despite this fact, the national autopsy rate is reported to be roughly 5 percent of hospital inpatient deaths according to a 2004 review on this topic. It is easy for physicians to assume to that, with today’s sophisticated imaging and other diagnostic modalities, nothing of significance escapes detection. However, recent reviews on this topic still show that approximately 4 to 6 percent of autopsies reveal unrecognized conditions that potentially would have altered care had they been discovered while the patient was alive.

This provides an excellent opportunity for pathology and laboratory leaders to engage their hospital and care system leadership regarding the importance of effectively utilizing this tool as we enter the next phase of value-based care reimbursement. This is something of real value that the laboratory brings to the table, and we would be foolish not to champion the use of this tool to help our organizations improve the quality of patient care.

ASCP staff and volunteer leaders are dedicated to providing excellence in education, certification, and patient advocacy to the medical community. Many other important issues in addition to those quality metrics mentioned here are also being addressed. With new genetic diagnostic tools and therapies on the horizon, it is both a challenging and exciting time to be engaged in the practice of pathology and laboratory diagnostics. ASCP is prepared to assist in providing the quality laboratory diagnostic support necessary to meet these challenges.


James L. Wisecarver, MD

2017-2018 ASCP Foundation President