[Histonet] Histotechs grossing

From:"Jasper, Thomas G."

Dear Heather and All,
Regarding histotechs grossing, I do not have the CLIA 88 rules in front of
me and certainly don't have them memorized.  I am not an attorney with
expertise in medico-legal matters.  Having said that, as an AP Coordinator
and a histotech, my understanding of histotechs grossing basically goes
something like this: A standard of service/care is evolving (at least in the
USA) with what our institution has defined as "minor gross dictations".
"Minor gross dictations" are for the most part dermatology and endoscopy
cases (occasional endometrial/cervical specimens as well).  These are
straightforward cases which require the accurate dictation of patient
demographics, clinical history (if provided), specimen source and/or the
identification of the specimen as indicated on a requisition.  This is then
followed by a physical description of appearance, color, size and number.
We generally close with a statement such as..."all submitted, or totally
submitted in a single block, two blocks"...whatever the case may be.  Every
institution is different and the way they run their services will vary.  I
do not expect my histotechs to do "minor gross dictations" very often.  We
have a full staff of pathologists and a PA (we are looking to obtain a 2nd).
The expectation with our service is that the PA and the pathologists will
handle the tissue grossing.  If the situation arises when a histotech (and
it is usually me) can knock down some "minor grosses" to keep "the machine
running" so to speak, we've met our objective.  The histotechs do not gross
large or complex cases and reserve the right to hold a case to defer to a
pathologist or PA.  As a matter of fact this is encouraged as we do not want
anyone to proceed if they are not comfortable or feel that something about a
particular case needs to be observed grossly by the pathologist or PA.
As I've implied this does not occur that often and when it does it is under
the direct or indirect supervision of the PA or pathologist.  Therefore, as
far as doctors not taking the blame and having histotechs go down in flames,
this type of scenario should not occur.  The pathologists are ultimately
responsible, even for the PAs.  They carry the malpractice and receive the
big bucks for making the calls.
As far as doing 2 jobs for the price of one I would not necessarily agree
with that mindset.  The majority of grossing that histotechs are "qualified"
to do (to my understanding) should not be of a complex nature.  Also, the
majority of the cases handled per day should not be of the type histotechs
are "qualified" to do.  As I've stated, all services are different, perhaps
someone out there is trying to get histotechs to gross cases which should be
handled only by pathologists or PAs.  Or, maybe there is some type of
pathology service that handles only non-complex pathology, I am unaware of
either type of work scenario.
What I do believe as positive for histotechs is the recognition that they
have enough intelligence and responsibility to handle grossing to the limit
of their qualification.  Just as other areas of Histology have expanded -
IHC, ISH, FISH etc. - I am viewing this grossing responsibility as a natural
expansion (evolution, if you like).  The educational standards are being
raised and when you couple that with the vacancy rates it only makes
histotechs more valuable.  I am not saying that I expect histotechs to do
more as far as putting in a workday.  For example we've got people doing IHC
etc., if there are busy working on something - whatever it is - I don't
expect them to drop it and go do minor grosses.  If it fits into the workday
and needs to be done, fine, I do not believe in piling on unmanageable
workloads just because people have additional skills.
This only my opinion and maybe somebody will think I'm all wet, but this is
how I see it as an administrator and a histotech.
Thomas Jasper HT(ASCP)BAS
Anatomic Pathology Coordinator
SMDC Clinical Laboratory
Duluth, MN

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