Reducing Errors in the Practices of Pathology and Laboratory MedicineAn Industrial Approach

Abstract

The use of quality benchmarking and performance tracking techniques has been successful in reducing errors in the practices of pathology and laboratory medicine. However, techniques developed in the manufacturing industry, specifically those pioneered by Toyota Motor have been more efficient and effective in reducing errors than those developed in the health care industry. We discuss some of those techniques and draw analogies as to how they might be applied in the laboratory. Traditional Approach to Error Reduction: Benchmarking and Best Practices For more than a decade and a half, the College of American Pathologists (CAP) has defined the nature of quality in the practices of laboratory medicine and anatomic pathology through its quality benchmarking Q-Probes program. By using these data collection tools, voluntary participants representing heterogeneous groups of hospitals and practice environments located in all geographic regions of the United States have measured standard parameters of quality. In each of these studies, enormous amounts of data were collected during periods lasting weeks to months. From these data, CAP statisticians have established benchmarks of laboratory performance. Participants have been able to gauge their performances relative to those of the national benchmarks determined in these studies and those of their peers participating in the studies. In each study, participants also have provided general information describing how laboratory services are provided in their institutions. CAP statisticians have used these data to determine which laboratory and professional practices are associated with superior outcomes.1-5 For example, 2 Q-Probes studies examined the frequencies of the following: (1) completion of 4 standard components of patient and blood unit identification before performing blood transfusions and (2) performance of required vital sign monitoring during the transfusions.6 Participants representing a total of 600 hospitals audited 16,494 transfusions. The median frequencies with which health care workers performed all patient identification and monitoring procedures ranged from 10.0% to 69.0% and 90.2% to 95.0%, respectively, in both studies. Individual practices and/or institutional policies associated with greater Reducing Errors in the Practices of Pathology and Laboratory Medicine An Industrial Approach David A. Novis, MD,1,2 and George Konstantakos3