National Histopathology Quality Improvement Programme

Giving patients greater confidence in pathology test results

The Histopathology National Quality Improvement Programme gives patients greater confidence in the diagnosis of illnesses, regardless of whether they are tested at a large or small hospital, either public or private.

The central aim of the programme is to ensure enhanced patient care and patient safety with timely, accurate and complete pathology diagnoses and reports.

Launched by the Faculty of Pathology in 2009, the programme aims to:

improve patient care by minimising diagnostic errors in Histopathology
develop a standardised national quality improvement system for Histopathology
enable individual laboratories to review their performance against national targets
identify good practice and areas requiring improvement and share findings with participating laboratories
provide evidence-based assurance to the public of the quality of Irish diagnostic services
improve communication between participating institutions.

Thanks to the programme, we can report on national metrics in histopathology, making Ireland the first country in the world to do so.

“Pathology, like many diagnostic services, involves decision making under conditions of uncertainty and an element of error is unavoidable. But an effective quality assurance programme that tracks error rates gives us the best chance to keep them to a minimum.”

Professor Conor O’Keane
Consultant Histopathologist, Mater Misericordiae University Hospital

What is Histopathology?

Diagnostic histopathology involves making diagnoses based on the microscopic examination of tissues removed during various operative interventions and procedures such as endoscopy, biopsy or resections.

The biopsy or surgical specimen is processed and histological sections are placed onto glass slides for examination under a microscope.

Cytopathology deals with diseases on the cellular level. A common application of cytopathology is the smear test, used to detect precancerous cervical lesions and prevent cervical cancer.

Why was this programme established?

The Histopathology National Quality Improvement Programme was developed by the Faculty of Pathology as a matter of priority following high-profile cancer misdiagnosis cases in 2007 and 2008.

The Faculty wanted to systematically produce robust evidence on histopathology services in Ireland against the highest international standards. It also wanted to address the lack of national standards or benchmarks for auditing pathology services.

This programme was known as the National Quality Assurance Programme in Histopathology until February 2015.

How the Programme Works

The Faculty of Pathology has set evidence based targets so that histopathology laboratories can track their performance in a number of key areas, for example how quickly test results are processed and reported.

Laboratories enter data relating to their performance against these targets in an online quality information system, which then calculates a national average.

Laboratories can see how they are performing compared to the national average and identify if there are issues that need to be addressed or areas in which they are excelling.

Laboratories that are performing better than average are encouraged to share their best practice approach with other laboratories, resulting in improved standards overall.

Guidelines for Histopathology departments

These guidelines outline quality improvement activities that should be carried out in a Histopathology department. All references to the National Quality Assurance Programme in Histopathology should now be read as the Histopathology National Quality Improvement Programme.

The guidelines were developed by a Working Group of consultant histopathologists appointed by the Faculty of Pathology.

The guidelines have been circulated to all public, private and voluntary hospitals in Ireland that provide histopathology services and are used by all participating histopathology laboratories.

Is your hospital using the National Quality Assurance Intelligence System?

An online tool for Quality Improvement data

An essential component of the Histopathology National Quality Improvement Programme is an online quality assurance system that was built to store, analyse and report on laboratories’ performance. It was developed by the Faculty of Pathology and HSE Health Intelligence Ireland.

Known as NQAIS (National Quality Assurance Intelligence System), it functions as a central repository for quality improvement data from the Laboratory Information System, LIS. It allows us to generate national reports on the accuracy and timeliness of diagnostic testing in hospital laboratories across Ireland.

All 25 of the public histopathology laboratories and seven private laboratories are currently using NQAIS.

Thanks to NQAIS, laboratories can spot best practice and variations from best practice, and monitor, review and improve the quality of their work in the context of national norms and targets set by the Faculty of Pathology.

We use NQAIS to produce an annual report on national metrics in histopathology, making Ireland the first country in the world to do so.

	Participating Hospitals
Beacon Hospital	Beaumont Hospital	Blackrock Clinic
Bon Secours Hospital, Cork	Bon Secours Hospital, Dublin	Bon Secours Hospital, Tralee
Cavan & Monaghan Hospital	Children's Health Ireland- Our Lady's Children's Hospital/ Temple Street	Connolly Hospital Blanchardstown
Coombe Women and Infants University Hospital	Cork University Hospital	Galway Clinic
Letterkenny General Hospital	Mater Misericordiae University Hospital	Mater Private Hospital - Dublin
Mayo General Hospital	Midlands Regional Hospital at Tullamore	Our Lady of Lourdes Hospital, Drogheda
Portiuncula Hospital	Rotunda Hospital	Sligo University Hospital
St. James Hospital	St. Vincent's University Hospital	Tallaght University Hospital
The National Maternity Hospital, Holles St	University Hospital Galway	University Hospital Limerick
University Hospital Waterford

“NQAIS is a hugely important advance in patient safety and treatment. As in any walk of life, medical error cannot be entirely eliminated, but this system will give Irish laboratories a unique advantage in monitoring the quality of their reporting and reviewing it against the national standard. This will drive improvement and ultimately reduce errors”

Professor Niall Swan
Consultant Histopathologist at St Vincent’s Hospital

Working with the Health Service

The Histopathology National Quality Improvement Programme is led by the Faculty of Pathology. It has received wide support and is governed by a Steering Committee with representation from:

Royal College of Surgeons in Ireland
HSE Quality Improvement Division (Sponsor)
Private Hospitals Association
HSE Office of the Chief Information Officer
HSE Acute Hospitals Directorate
Department of Health
Consultant Histopathologists
National Office of Clinical Audit
Health Information and Quality Authority (HIQA) – observer

"Ireland is the first country in the world to publically report national metrics on the quality of their pathology system. This should help assure the Irish people that important aspects of medical safety and quality continue to be carefully monitored.”

Professor John Srigley
Expert Lead for Pathology, Canadian Partnership Against Cancer

An award-winning programme

The Histopathology National Quality Improvement Programme won an award for Excellence in Healthcare Management at the Irish Medical Times Healthcare Awards which took place at the Shelbourne Hotel on Thursday, 5 November 2015.

The judges commended the programme as a key initiative in enhancing patient safety which has received wide support from organisations within the healthcare sector.

Read the full news story

"With its annual nationwide quality evaluation system, the Irish Histopathology National Quality Improvement Programme really embodies Peter Drucker's statement 'What Gets Measured Gets Improved'. I am confident that this programme will continue to improve quality and patient safety in Ireland. Really impressive!"

Professor Omar Hameed
Regional Medical Director, Hospital Corporation of America; Adjunct Professor of Pathology, Vanderbilt University Medical Center

Áine Mitchell

Programme Manager, National Histopathology Quality Improvement Programme

Tel: +353 (0)1 863 9759

Caitríona McGrath

Department Manager, Specialty Quality Improvement Programmes

Tel: 01 8639 658

Caitríona is the Department Manager for the Specialty Quality Improvement Programmes in:

GI Endoscopy
Radiology
Histopathology