Dear David

Just to add my tuppence worth to this topic. Biomedical scientists have been
dissecting all specimens in our Histopath. lab. since 1954. In our
experience any "mucking up" as you refer to it is usually a result of either
trainee pathologists(we are a teaching Hospital) or pathologists becoming
involved in dissection of cases.
These Biomedical staff (Techs as you refer to them) are highly trained,
experienced individuals. Most with BSc.degrees and many with  Masters
degrees and a few with PhD's.
This practice has been carried out here for almost fifty years, and works
very well. It allows for a more economic delivery of service. You do not
need a medical degree to dissect specimens(this is protectionism by the
medical profession and applies equally in other areas of the hospital), but
you do need to know what you are doing, this is were a good on the job
training program is essential. Textbooks and paper qualifications are all
very well but you need to see and handle the specimens for yourself in order
to identify tumours and know why you are taking various blocks to
demonstrate certain aspects of the specimen. As regards error's there are
systems in place to identify these, but generally speaking these are few and
far between and are picked up before the case reaches the pathologist for
reporting.
The guidelines you have identified from your accrediting authority, are
similar to those produced by the Royal College of Pathologists earlier this
year. Somewhat restricting for this Laboratory, however I do recognize the
need for a balance to be struck between safety and an enhanced role for
histo.lab staff. The key relationship is how much trust/confidence the
reporting pathologist has in the laboratory staff.
I would be very interested to read any other guidelines which have been
produced on specimen dissection in pathology labs in other parts of the
world.

Liam Brennan
Histopathology Dept.
Belfast City Hospital
Northern Ireland
> ----------
> From: 	David Taylor Manager[SMTP:DTMan@kingmower.com.au]
> Sent: 	03 October 2001 09:38
> To: 	Histonet (E-mail)
> Subject: 	RE: Tech grossing - some more thoughts
> 
> Dear Mike, this is obviously a hot topic around the world. My view is
> that there is a risk of tech's "mucking up" in many areas of specimen
> preparation. Embedding punch bxies on their head, mixing lab. numbers
> up, even losing specimens. The result is the same, a patients specimen
> has not been handled as deserved. At the end of the day it doesn't
> matter who made an error but that an error was made. We all know
> mistakes are made, (not in your or my lab of course) but unfortunately
> in our industry the consequences are or can be devastating. Mistakes are
> not acceptable and systems must be put in place to prevent their
> occurrence. The pathologist reporting the case is responsible for all
> actions on that case, even if another pathologist/ technician made an
> error in cut-up, the reporting pathologist's name goes on the bottom of
> the report.
> With regard to litigation, technical staff are covered by the fact that
> pathologist's are the ones who sign out the report, unlike cyto
> screeners who often have separate indemnity insurance.
> Recently, we in Australia have been given guidelines for the performance
> of the pathology surgical cut-up by NPAAC, (National Pathology
> Accreditation Advisory Council). This body is made up of representatives
> of, The Royal College of Pathologist of Australasia, The Australian
> Institute on Medical Scientists and others. To read in full go to
> http://www.health.gov.au/haf/pubs/pubs.htm and scroll down to NPAAC
> publications. At the end of this list is the document I refer to.
> 
> I don't have any problem with well trained/ supervised technical staff
> performing technical cut-up to a point. I guess this is where it gets
> grey. Technical staff must be able to recognise when a specimen is not
> the same as the others that came before it. This is why the above
> document is very important along with the strict training/ monitoring it
> requires. I'm sure debate will continue for a long time yet. David.
> 
> PS. One of the benefits of technical cut-up is that the blocks are
> thinner, flatter and not jammed into the cassette, cos workmates won't
> be as shy to peers as pathologist's.
> 
> David Taylor
> Laboratory Manager
> Drs King & Mower
> Adelaide, Australia
>  
> 
> -----Original Message-----
> From: Mike Kirby [mailto:mikek@mail.saimr.wits.ac.za]
> Sent: Friday, 28 September 2001 16:36
> To: Histonet
> Subject: Tech grossing - some thoughts
> 
> 
> 
> Rose Richardson asked how many Tech's are doing tissue grossing, as this
> is
> not allowed in her Path Dept.
> And so it should be, because have any of the Tech's that are doing this
> work, given any thought to the fact that they could face serious
> litigation
> should they make a "muck-up".
> I have no doubt that there are Techs that are very good at it, but one
> slip,
> and you could be deep in the brown stuff.
> Leave it to the Pathologists - that's what they trained to do and that's
> what they are paid for.
> 
> Mike Kirby
> Johannesburg
> South Africa.
> 
> 
>