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July 21, 2010

Pathology Audit Methodology
Filed under: Bristol Pathology Inquiry — Dr. Phil @ 9:59 pm

Pathology Methodology

This is the methodology, acquired under the Freedom of Information Act, that University Hospitals Bristol NHS Foundation Trust (UHB) used to select 3,500 cases/specimens (it’s never been made clear which), for one year only, 2007,  in response to an “allegation that there was a high error rate in the Bristol Royal Infirmary Histopathology Department”. Except nobody made that allegation. It was alleged that some serious errors have been made in the areas of respiratory, breast, gynaecological and skin histopathology, affecting patients of North Bristol NHS Trust (NBT) some of them going back to 2000.

The rule of selecting every fourth case was used until the methodology was found to have selected more specimens for one pathologist than the others. UHB then changed the rules so that each pathologist contributed approximately 550 things (cases or specimens?) to the audit. Whether these numbers reflect the relative caseloads of the pathologists is not known.

This methodology is likely to have delivered UHB’s desired audit result of an error rate of less than 2% for the 3,500, but it won’t answer the question of whether there have been serious, avoidable errors in the reporting of breast, respiratory, gynaecological and skin histopathology for both UHB and NBT patients from 2000 to the present.

Over a year after the 3,500 audit was announced we still don’t know whether it is 3,500 cases (an occurrence of disease or a disorder in a patient) or specimens (samples of tissue used for analysis and diagnosis).

As many cases will each have more than one specimen that has been considered in making a diagnosis, it would seem rather important to understand what exactly has been audited. Odd that Jane Mishcon’s Inquiry Panel hasn’t sought clarification for the public on this matter.