A six sigma trial for reduction of error rates in pathology laboratory

Abstract

Objective: A major target of quality assurance is the minimization of error rates in order to enhance patient safety. Six Sigma is a method targeting zero error (3.4 errors per million events) used in industry. The five main principles of Six Sigma are defining, measuring, analysis, improvement and control. Using this methodology, the causes of errors can be examined and process improvement strategies can be identified. The aim of our study was to evaluate the utility of Six Sigma methodology in error reduction in our pathology laboratory. Material and Method:The errors encountered between April 2014 and April 2015 were recorded by the pathology personnel. Error follow-up forms were examined by the quality control supervisor, administrative supervisor and the head of the department. Using Six Sigma methodology, the rate of errors was measured monthly and the distribution of errors at the preanalytic, analytic and postanalytical phases was analysed. Improvement strategies were reclaimed in the monthly intradepartmental meetings and the control of the units with high error rates was provided.Results: Fifty-six (52.4%) of 107 recorded errors in total were at the pre-analytic phase. Forty-five errors (42%) were recorded as analytical and 6 errors (5.6%) as post-analytical. Two of the 45 errors were major irrevocable errors. The error rate was 6.8 per million in the first half of the year and 1.3 per million in the second half, decreasing by 79.77%. Conclusion:The Six Sigma trial in our pathology laboratory provided the reduction of the error rates mainly in the pre-analytic and analytic phases.

Errors in Surgical Pathology Laboratory

“…The A3 method is based on defining a problem, analyzing its causes, aiming at an ideal practice, and providing an improvement plan [9]. Other authors have also used industrial techniques, such as the Six Sigma, with excellent results in error reduction [16,38]. Examples of their measures were as follows: meetings with the clinical teams responsible for delivering the material to correct the inadequacy of the samples and intradepartmental meetings, in which employees actively participated in the discussions about the errors and their solutions.…”

“…Of these, 88% (n = 432) of errors were found in the pre-analytical phase, in terms of the order, identification, collection, transportation, material reception, and processing in the laboratory. The authors identified 20% (n = 4) of analytical and 39% of (n = 8) post-analytical errors [15], as shown in Table 1, associated with Tosuner [16] survey data.…”

“…Delays in the report release may be considered as an error in the post-analytical [15] or analytical phase [16], and the turn-around time (TAT) should be used as an important quality measure in laboratories [32]. It is not uncommon for the pathologist to miss the perception that there is a patient waiting for his results; therefore, the cases should not remain for longer than necessary on the pathologist's desk [33].…”

Assessment of Quality and Risks Exposure in Histopathology Department

“…The analytical phase is reserved to microscopic evaluation of the slide and conceive the pathological report. Mistakes within this phase are encountered with a wide range of frequencies from 4 % (11) to 42.1% (6).…”

“…Mistakes during tissue processing due to technical problems (power failure, incorrect was impregnation, different technical fault of automatic tissue processor or of cryostat, poor dehydration) Involving the patient Wrong identification data of the patient because of wrong labelling Mixing up the surgical probes Not having access to clinical data regarding the history of the patient or to different initial laboratory tests. Analytical phase (2,6,11,12) Intra-operative…”