Redefining and capturing pre-analytic deficiencies in an anatomical pathology laboratory: a quality improvement initiative.

Pre-analytical deficiencies (PADs) are a major source of errors in anatomical pathology, accounting for about 70% of laboratory deficiencies. These can lead to incorrect diagnoses, delayed treatments, and increased healthcare costs. As part of a quality improvement initiative, we retrospectively identified and characterized 237 PADs documented over a 1-year period in a tertiary care academic center. The most common PADs were errors in specimen procurement (56%), handling of samples within the lab (16%), accessioning (10%), incomplete requisitions (9%), and transportation-related issues (7%). Strategies were then devised to mitigate these errors. Categorization of pre- and intra-laboratory PADs was refined into eight categories (collection, requisition, specimen container, transportation, receiving, accessioning, preparation, and communications) in the laboratory information system. Mandatory PAD documentation was implemented for accessioning staff. Post-implementation, prospective analysis identified that the most common PADs were related to surgical requisitions (75%). Among these, missing ordering physician's signature was the most common, accounting for 67.7% of requisition-related PADs and 50.8% of all PADs. Other common PADs included incomplete information of specimens, clinical information, patient information, physician information, source location, collection time, incorrect requisition forms, and illegible handwritten information. This study highlights the importance of identifying and addressing PADs in the anatomical pathology laboratory setting as well as the potential benefits of implementing standardized documentation and quality improvement processes to address these deficiencies.

The role of the Professional Doctorate in developing professional practice.

AIMS: The present study aims to reflect on, and analyse, one particular approach to the award of a Professional Doctorate. BACKGROUND: The concept of the 'Professional' Doctorate offers opportunities for the development of work-based skills which transcend professional boundaries. There is now an established basis for Professional Doctorates with many Universities offering a qualification of this nature. EVALUATIONS: It commences with a consideration of what the Professional Doctorate is, the philosophy of the Professional Doctorate and how it can impact on professional practice. KEY ISSUES: The key issues are underpinnings of the Professional Doctorate which is concerned with Mode 2 knowledge and the ways in which the Professional Doctorate can enhance and develop practice. CONCLUSIONS: Conclusions are then drawn which the authors believe will be of use to those managing, developing and studying on, Professional Doctorate programmes. IMPLICATIONS FOR NURSING MANAGEMENT: The present study then explores the issues which the authors have experienced over the past 5 years in running the scheme and highlights the potential benefits of the professional doctorate for organizations.

Creating a code of conduct to enable organizational change.

This article provides an overview of the elements that were involved in developing a comprehensive change management strategy at a large, multi-site laboratory as it readied for a major environmental change in the clinical laboratory. A multi-year strategic and tactical plan was created based on an organization-wide employee satisfaction survey, an environmental survey, business needs, and internal/external pressures. The goal was to build a collaborative, team-oriented, and respectful place to work, and to ensure that the workplace became a vibrant environment focused on both individual growth and business improvement and efficiency. This article presents the strategy and outcome of the change, including external and internal environmental influences, challenges, and successes. It also discusses the dissemination of information and engagement of staff, clarification of roles and responsibilities, code of conduct, career laddering and career self-management, and a review of deficiencies impacting efficiency and productivity.