Are College of American Pathologists Accreditation Standards Relevant Outside North America?

To the Editor.—We describe our experience within the Division of Anatomic Pathology at Cornwall Regional Hospital in Western Jamaica in testing the local relevance of a widely known laboratory quality assurance protocol. Although several protocols exist, those described by the College of American Pathologists (CAP) are widely recognized.Cornwall Regional Hospital is the main health facility on the West Coast of Jamaica. It has a bed capacity of 500 and receives approximately 80 000 patients from a geographic base of approximately 500 000. Approximately 100 physicians provide comprehensive medical services. The Division of Anatomic Pathology (AP) is part of the Department of Pathology, which is further subdivided into histology, cytology, and autopsy units. The AP laboratory occupies an area of approximately 1400 sq ft (427 m2). At the time of our inspection, there was 1 pathologist, 1 cytotechnologist (MSc degree), 2 medical technologists (BSc degree), 2 clerical officers, and 2 autopsy assistants, all full-time. The main equipment included 1 tissue processor, 1 cryostat, 2 microtomes, a refrigerator and 2 fume hoods, an automated stainer, 2 autopsy beds, and a morgue refrigerator with capacity for 12 bodies. A separate storage area of 200 sq ft (61 m2) for processed tissue, slides, and paraffin blocks is attached to the morgue. Annual intake averages 3000 or more surgical pathology specimens, 6000 Papanicolaou smears, 180 fine-needle aspiration biopsy specimens, 400 fluid samples, and 400 bodies for autopsy.Both authors conducted the inspection throughout 3 days, using the CAP checklists published in 2000.12 Only the lead inspector, who had prior training and experience in laboratory inspections, knew that an inspection was scheduled. Criteria relating to National Committee for Clinical Laboratory Standards and Centers for Medicare and Medicaid Services were excluded, since these were not of obvious local relevance. The results indicated that the laboratory easily satisfied most of the criteria. Tables 1 and 2 show “deficiencies.”A lack of regular manual updates was one reason for deficiencies in quality control, whereas space and ventilation accounted for most deficiencies in the physical facility and safety. The hospital administration took quick action to modify the work and safety environment. We also updated manuals and added written parameters to our quality assurance protocols. Funding would be required to participate in North American–style interlaboratory comparison programs, although local quality control was ensured by regular random and selected review of our cases by pathologists at the National Public Health Laboratory and the University of the West Indies, both in Kingston, Jamaica.Computerization of administrative protocols (eg, manual updates) would improve compliance particularly in the histology laboratory, especially in times of staff shortage. With slight modifications, CAP criteria can be readily exported to supplement local quality assurance tools.

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