Laboratory Management in Anatomic Pathology

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In this issue of American Journal of Surgical Pathology: Reviews and Reports, we take a brief detour from the usual diagnostic focus of the journal, to discuss a potpourri of laboratory management issues in the anatomic pathology (AP) laboratory.

Why would I do this to you? Why can't I just leave you to learn about cool tumors and grow your diagnostic skills?

Anatomic pathologists care deeply about being the best diagnostician they can be. They work hard to learn diagnostic criteria, keep up with the latest literature, and carefully study each challenging case to arrive at the best possible diagnosis. But we fool ourselves if we believe that we can ignore everything that happens in the laboratory to get those slides to our office and that report to the patients and their providers. What good is the best diagnosis if the tumor tissue was actually a contaminant from another patient (Anderson, et al)? Or if the diagnosis is assigned to the wrong patient because of an accessioning error (Jacobs and Staats)? How sure are you that your clinician understands exactly what you have written in your report (Findeis, et al)? Laboratory management requires a different skill set and a willingness to work outside our natural comfort zone of traditional pathology training, but it is every bit as important to our patients as our diagnostic work, and people who are willing and able to do it are invaluable to the laboratory.

Laboratory management is often categorized in residency programs as a clinical pathology rotation, and the clinical laboratories have without a doubt run ahead of AP in implementing many management and quality tools in the past, but today's modern AP laboratory is rapidly catching up in this regard, because of the pull of enlightened laboratory leadership realizing the value of these techniques, as well as the push of regulatory requirements. This issue focuses particularly on some of the unique aspects of laboratory management in AP. However, a single issue cannot possibly cover every aspect of AP laboratory management, and rather than focus narrowly on one specific area, this issue chooses to present articles touching on a wide range of topics.

We start with a very common issue in AP: a discussion of a particularly challenging case of the dreaded “floater” by Anderson, Amin, and Bernacki. This common issue in AP poses a substantial risk to patients if the pathologist does not keep an open mind, and the investigation can be challenging.

We then turn to a series of articles on quality metrics. DeSimone and Heher discuss the classic metric of “turnaround time” in a new light. Jacobs and Staats discuss the value and challenges of reporting and tracking errors in AP. Vander Laan discusses novel metrics to assess individual provider performance in the diagnosis of thyroid cytology specimens. Although focused specifically on thyroid cytology, this discussion also provides a framework for thinking about diagnostic metrics more broadly in pathology. Dahl, Myers, and Pantanowitz discuss the use of data-driven decision-making across a broad range of laboratory management issues.

Next, we turn to postanalytic communication. First, Findeis, Huber, and Whitney-Miller discuss ambiguity in the written pathology report. Then, Kallen, Otis, and Staats discuss communication of urgent and significant unexpected (critical) diagnoses in AP.

We close with an experience living through the unimaginable, as Stowman and Kalof detail the University of Vermont's experience with a nearly month-long complete technology shutdown following a cyberattack, and how an Incident Command Structure was used to regain laboratory function.

I hope you enjoy this detour from diagnosis into laboratory management and that some of these articles cause you to think about a broader role for you as a pathologist in your laboratory, not just as a diagnostician but as a laboratory manager.

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