SURGICAL PATHOLOGY SPECIMEN IDENTIFICATION AND ACCESSIONING - A COLLEGE-OF-AMERICAN-PATHOLOGISTS Q-PROBES STUDY OF 1004115 CASES FROM 417 INSTITUTIONS

Objective.-To examine and suggest improvements for deficiencies occurr ing in the specimen identification and accessioning process in the sur gical pathology laboratory. Design.-Using the College of American Path ologists' and the joint Commission for Accreditation of Healthcare Org anizations' requirements as the standard, each laboratory was asked to prospectively document deficiencies in specimen identification and ac cessioning for 4 months, or until a maximum of 4000 cases or 400 defic iencies were accrued. Participants.-Four hundred seventeen laboratorie s in the College of American Pathologists' voluntary quality improveme nt program, Q-Probes, participated in this study. Results.-Identificat ion and accessioning deficiencies were found in 60 042 (6%) out of a t otal 1 004 115 cases accessioned (median deficiency rate of 3.4%). Err ors related to specimen identification accounted for 9.6% of these def iciencies, discrepant or missing information items were present in 77% , and 3.6% involved specimen handling. The most common deficiency was ''no clinical history or diagnosis present on the requisition slip,'' which represented 40% of all deficiencies. Deficiencies were most ofte n detected by the person assigned to accessioning duties or by histolo gy personnel. In 66% of cases, no action was taken to remedy the defic iency, but this varied dramatically according to the specific type of deficiency. An action was taken to remedy deficiencies in 69% of cases involving specimen identification errors, in 58% of specimen handling errors, and in 27% of cases with discrepant or missing information. P eer group stratifiers were associated with a lower deficiency rate. La boratories with lower numbers (<15 000) of accessioned cases and labor atories with a formal written plan for the detection of errors in acce ssioning and specimen identification reported lower rates of deficienc ies. Factors that correlated with a higher rate of deficiencies includ ed submitting the specimen container and requisition slip in a unique secondary container (P < .005) and labeling the specimen container wit h only a patient's name or unique patient identification number (as op posed to both identifiers). Conclusions.-The majority of deficiencies occurring in surgical pathology specimen identification and accessioni ng are related to missing or inaccurate clinical information. Deficien cies are detected in multiple locations, including areas not typically thought of as quality check points, such as transcription. A variable amount of effort occurs to rectify deficiencies; this effort is large ly dependent on the type of deficiency involved, Finally, laboratories with a formal error detection plan had fewer deficiencies.