What do you think is the best way ensure diagnostic quality in a dermatopathology laboratory? This is a question we have been grappling with and addressing in our laboratory. Of course, all laboratories have to deal with this problem.

There are common sense ways to approach this question. Here are a few that we perform currently:

1. Any case that is reviewed by anyone other than the dermatopathologist of record is referred to in the report, and it is documented so that a report of "multiple sign-off" cases is available. (This is a pre-signed-off review.)

2. Any case requested for review by an outside institution is reviewed by the dermatopathologist of record before it is sent out. (This is a post-sign-off review.)

3. Any case that goes to a clinical conference is presented by the dermatopathologist of record. (This is a post-sign-off review.)

4. Random 1% post-sign-off review by a dermatopathologist who is not the dermatopathologist of record. This is done on cases signed out within the last three weeks. (This is a post-sign-off review.)


When errors are discovered, they are addressed immediately, the clinician is contacted, and a corrected report is generated.

I am curious to know how others do it. Does anyone reading this blog think that the above is an adequate amount of review for quality improvement? If not, why not? What else should be done?