Re: [Histonet] Training for gross

From:Patti Loykasek



This question is an easy one to mis-read. By reading the note following the
question you can figure out what CAP actually means. Here's the note:

NOTE:  Two levels of complexity of macroscopic tissue examination are
defined, as follows:
 1) Processing is defined as a tissue examination limited to description=2C
inking and cutting of the specimen (if applicable), and submission of the
entire specimen to histology.  Tissue processing can be performed according
to standardized protocols.  Processing is generally limited to small
specimens (skin ellipses, small biopsies, curettings, etc.) and does not
require knowledge of anatomy.
2) Grossing (or gross examination) is defined as a tissue examination
requiring a greater exercise of judgment and a knowledge of anatomy.
Dissection of the specimen and selection of tissue samples for submission to
histology are generally required.  The specimen description is not
necessarily standardized.

In a latter question this is addressed:
 
ANP.11665            Phase I
Are there written procedures for processing specimens?
 NOTE:  This question refers to processing as defined in ANP.11600, and
applies only to processing of specimens by non-pathologist individuals who
are not qualified as high complexity testing personnel under CLIA-88.

I take this to mean that personnel who are not classified as high complexity
personnel can  perform processing of specimens as long as there are explicit
SOPs. When I inspected a small lab last year where histotechs were
processing╣ small, uncomplicated specimens, the documentation I required
was that there were specific SOPs for each type of specimen they were
grossing & that the pathologists had signed off on their competency
assessment for these tasks.


Patti Loykasek BS, HTL, QIHC
Clinical IHC Supervisor
PhenoPath Laboratories
Seattle, WA






> Because tissue processing, in 98% of all our laboratories in general and in
> all the histopathology labs is done by tissue processors, automatically. Only
> some labs doing electron microscopy still process samples manually and if a
> machine can process tissue, it cannot be considered as a "high complexity"
> task.
> RenÚ J.
> 
> --- On Tue, 8/26/08, lamarti2@gundluth.org  wrote:
> 
> From: lamarti2@gundluth.org 
> Subject: RE: [Histonet] Training for gross
> To: "Caldwell, Lia" 
> Cc: histonet@lists.utsouthwestern.edu,
> histonet-bounces@lists.utsouthwestern.edu, "Sharon.Davis-Devine"
> 
> Date: Tuesday, August 26, 2008, 2:20 PM
> 
> Question....   under CAP guideline ANP. 11600 ....is "Processing" (vs
> "grossing/gross examination) considered  a form of high complexity
> testing?
> 
> The reason I ask is because under CAP guideline ANP.11610  the statement is
> - "If individuals other than
> a pathologist, etc., assist in 'GROSS EXAMINATIONS", do such
> individuals
> qualify as HIGH COMPLEXITY testing
> personnel under CLIA-88 regulations?"  There is absolutely NO mention of
> qualifications for individuals performing
> tissue "PROCESSING".
> 
> 
> 
> Lisa A. Martin, PA (ASCP)
> Gundersen Lutheran Medical Center
> 
> 
> 
>                  
>            "Caldwell, Lia"
>    
>                        adHospitals.com>                                           To
>            Sent by:                  "Sharon.Davis-Devine"
>    
>            histonet-bounces@         
> 
>            lists.utsouthwest                                          cc
>            ern.edu                   histonet@lists.utsouthwestern.edu
>                                                                  Subject
>                                      RE: [Histonet] Training for gross
>            08/22/2008 04:54
>            PM    
>                  
>                  
>                  
>                  
> 
> 
> 
> 
> Sharon,
> This came up during a recent CAP inspection of a lab we inspected in
> Maricopa so I have taken the liberty of copying the information from the
> CAP guidelines regarding this issue for you.  The first question defines
> high complexity testing and the second question addresses requirements for
> individuals performing these tasks.
> Hope this helps, have a great weekend!
> ~Lia
> 
> 
> According to CAP guidelines
> 
> ANP.11600
> 
> "Are all macroscopic tissue examinations performed by a pathologist or
> pathology resident, or under supervision of a qualified pathologist=3F
> 
> Note:  Two levels of complexity of macroscopic tissue examination are
> defined, as follows:
> 
> 1.  Processing is defined as a tissue examination limited to description,
> inking and cutting of the specimen (if applicable), and submission of the
> entire specimen to histology.  Tissue processing can be performed accroding
> to standardized protocols.  Processing is generally limited to small
> specimens (skin ellipses, small biopsies, curettings, etc.) and does not
> require knowledge of anatomy.
> 
> 2.  Grossing (or gross examination) is defined as a tissue examination
> requiring a greater exercise of judgement and a knowledge of anatomy.
> Dissection of the specimen and selection of tissue samples for submission
> to histology are generally required.  The specimen description is not
> necessarily stadardized.
> 
> ANP.11610
> 
> "If individuals other than a pathologist or pathology resident assist in
> gross examinations, do such individuals qualify as high complexity testing
> personnel under CLIA-88 regulations?
> 
> NOTE:  The laboratory director may delegate the dissection of specimens to
> non-pathologist individuals;  these individuals must be qualified as high
> complexity testing personnel under CLIA-88 regulations.  The minimum
> training/experience required of such personnel is:
> 
> 1.  An earned associate degree in a laboratory science or medical
> laboratory technology, obtained from an accredited institution, OR
> 2.  Education/training equivalent to the above that includes at least 60
> semester hours or equivalent from an accredited institution.  This
> education must include 24 semester hours of medical laboratory technology
> courses, OR 24 semester hours of science courses that includes 6 semester
> hours of chemistry, 6 semester hours of biology, and 12 semester hours of
> chemistry, biology or medical laboratory technology in any combination. In
> addition, the individual must have laboratory training including either
> completion of a clinical laboratory training program approved or accredited
> by the ABHES, the CAHEA, or other organization approved by HHS (note that
> this training may be included in the 60 semester hours listed above)=2C OR at
> least 3 months documented laboratory training in each specialty in which
> the individual performs high complexity testing.
> 
> In addition, the CLIA-88 regulations include exceptions for grandfathered
> individuals; these regulations (42CFR493.1489 and 1491) may be found at
> http://www.phppo.cdc.gov/clia/regs/subpart_m.aspx#493.1487
> 
> It is the responsibility of the laboratory director to determine whether an
> individual's education, training and experience satisfies the requirements
> of this checklist question.
> 
> This checklist question applies only to laboratories subject to CLIA-88
> 
> 
> 
> Lia M. Caldwell HT (ASCP)
> Histology Supervisor
> Oro Valley Pathology Dept.
> phone: (520) 901-3914
> www.Lia.Caldwell@TriadHospitals.com
> "be yourself - everyone else is already taken." -unknown
> 
> _______________________=5F________
> 
> From: histonet-bounces@lists.utsouthwestern.edu on behalf of
> Sharon.Davis-Devine
> Sent: Fri 8/22/2008 10:23 AM
> To: histonet@lists.utsouthwestern.edu
> Subject: [Histonet] Training for gross
> 
> 
> 
> For all of you Histonetters out there I have a question about training
> individuals to gross in small specimens.  Can a person with a degree and
> being a Cytotechnologist, Medical Technologist or a Histotechnologist
> gross in small biopsy samples?  And if they can, what kind of training
> is required and for how long?  We are losing one of our PA's and are
> contemplating replacing that person with a person with a degree. Thanks
> for the info.
> 
> 
> 
> Sharon Davis-Devine, CT (ASCP)
> 
> Cytology Supervisor
> 
> Carle Clinic
> 
> 602 West University
> 
> Urbana, Illinois 61801
> 
> Phone:  217-383-3572
> 
> Email:  sharon.davis-devine@carle.com
> 
> 
> 
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