Estudio de control de calidad en exámenes anatomopatológicos del cuello uterino

Background: Medical care quality is assessed by a series of actions performed in a periodic and continuous way in order to timely identify and to correct defficiencies. Objective: To evaluate the quality of the anatomopathologic diagnosis in three kinds of specimens: cervix uteri biopsies, cervical conizations and the whole cervix as part of the hysterectomy surgical pieces. Material and methods: In a six-month period 310 biopsy-specimens, cone and hysterectomy specimens were reviewed, the sample size was determined by means of statistical calculation and the confidence interval was 95%. We included 60 cases with malignant tumors and 250 with benign lesions. Assessment included available resources, activity developed routinely by all personnel, diagnostic certainty and the result expressed in a written report. Results: The analysis reveled that the anatomopathological studies in this Department has low quality. The main problems were: 1) poor quality in the histological preparations in a high proportions of cases; 2) a long time displayed between the material reception and the elaboration of the written final inform (14.7 ± 7.5 days); 3) a low diagnostic accuracy (kappa = 0.53). Conclusions: Contrary to any supposition, a lack of resources was not the more important factor in the problems’ origin. They were the service’s bad organization; the lack of individual productivity indicators; the absence of personal motivation; and the adequate personal preparation in any technicians and doctors. Continuous or periodical quality control evaluations are the only one mechanism which permit detect this problems and their opportune correction.