PATHOLOGISTS’ ASSISTANT: alta formazione e management

in anatomia patologica

VI Congresso Nazionale FITeLab - VERONA

Chiara Arzenton

SCARSITA’ DI RISORSE

INNOVAZIONE

TECNOLOGICA APPROPRIATEZZA

PRESTAZIONI EFFICIENZA

LA SFIDA

MUTAMENTI ORGANIZZATIVI

STRUTTURA

CULTURA

PROFESSIONALITA’

TECNICO DI LABORATORIO: sviluppo formativo e professionale

1. DM 745/1994: profilo professionale. 2. L 42/1999: TLB come professionista sanitario. 3. DM 3/11/1999 n 509 (Riforma Universitaria)e DMURST 5/6/2001 4. L 251/2000: autonomia professionale. 5. L 1/2002: accesso diretto a Laurea Specialistica e Master. 6. L 43/2006: coordinamento sanitario, coordinamento specialistico

e dirigenziale.

IL CAMBIAMENTO

NUOVI MODI DI LAVORARE

NUOVE INTERRELAZIONI TRA LE DIVERSE FIGURE PROFESSIONALI

NUOVE COMPETENZE

BACKGROUND

“Changes in health care economics and organization have resulted in increased use of non-phisician providers in most health care setting”

“Use of Phisician Extenders in Surgical Practice: the Pathology Assistant” Raulli, Fabbri, Curcio Rubertini. 6° Congresso Triennale Siapec- 2013

“…regarding surgical pathology, in USA and Canada, the use of phisician extenders,

Pathologist’ Assistant whose expertise lies in gross examination of surgical specimen, is

common”(since 1969)

CHI E’ IL PATHOLOGISTS’ ASSISTANT?

E’ UN PROFESSIONISTA DI LABORATORIO ALTAMENTE QUALIFICATO CHE ESEGUE IN AUTONOMIA L’ESAME MACROSCOPICO E I PRELIEVI DEI CAMPIONI CHIRURGICI E DEGLI ESAMI ESTEMPORANEI

AAPA American Association of Pathologists’ Assistant

SCOPE OF PRACTICE FOR PAs’

SURGICAL PATHOLOGY

AUTOPSY PATHOLOGY

ADMINISTRATIVE DUTIES

SURGICAL PATHOLOGY

• specimen accessioning

• obtein clinical history

• describe gross features of surgical specimen

• prepare tissue for proccessing for light microscopy

• obtain samples for studies such as flow analysis, research, cytogenetics,cultures, electron microscopy, immunofluorescence

• perform special procedures including x-ray imaging, frozen section, tumor triage

• photograph gross specimens and microscopic slides

AUTOPSY PATHOLOGY

• assure legal authorization for autopsy • obtain medical reports/charts for review • consult with attending pathologist to identify special

techniques to be utilized during the examination, including culture, toxicology, coronary artery perfusion, enucleation, etc.

• coordinate any requests for special specimen sampling such as organ transpalntation, research

• perform postmortem examinations including external exam, in-situ organ inspection, evisceration, organ dissection and dictation of findings

• prepare tissues for processing for light microscopy and special studies

• photograph the body, organs, microscopic slides and other pertinent materials

ADMINISTRATIVE DUTIES

• Maintenance of surgical/autopsy pathology protocols,procedures,reports and data

• assure proper maintennce of equipment

• assure provision of adequate supplies for and cleanliness of the surgical and autopsy suites

• assist in organization and coordinate of pathology conferences

• assist in preparation for accreditation inspections (CAP, Joint Commission)

• performance of budgetary duties

• performance of supervisory/management duties

PATHOLOGISTS’ ASSISTANT, PA (ASCP) EXAMINATION CONTENT GUIDELINE

SUBTEST DESCRIPTION EXAM PERCENTAGE

Fundamental of Patholgy Applications of Pathology and Desease States

40-50%

Anatomic Pathology Techniques

Principles and techiniques related to autopsy

pathology, and histological techniques

10-15%

Anatomy Normal Microscopic Anatomy, Gross Anatomy

10-15%

Autopsy Pathology Basic principles and techniques of adult, neonatal/perinatal,

pediatric, and medicolegal/forensic

10-15%

Laboratory Operation Regulatory and Compliance, Management,

Safety and Infection Control

5-10%

GROSSING PERSONNEL POLICY Mayo Clinic – Hospital Laboratory Jacksonville, Florida

GROSS EXAMINATION: defined as a tissue examination requiring a

greater exercise of judgement and knowledge of anatomy. Dissection of the specimen and selection of tissue for submission to histology are generally required. The specimen description is not necessarily standardize.

PROCESSING EXAMINATION: defined as tissue examination limited to

description, cutting of the specimen (if applicable), and submission of the entire specimen to histology. Tissue processing can be preformed according to standardized protocols. Processing is generally limited to small specimens (skin biopsies, small biopsies, currettings, etc.) and does not require knowledge of anatomy.

GROSS EXAMINATION Performed by Pathologists’ Assistant that has a national certification

with American Society of Clinical Pathologist (ASCP)…,is approved for the following specimens without direct supervision of a Pathologis.

1. Skin margin cases as well as all skin biopsies

2. Femoral heads and other bone resection cases

3. Uterus, tubes and ovaries 4. Appendix 5. Colon resection and all

gastrointestinal biopsies 6. Small bowel resection 7. Gallbladder 8. Radical prostatectomies, TURP’s and

prostate biopsies 9. Placental, cervical biopsies 10. Fetus of less than 20 weeks

gestational age or < 500g 11. Kidneys and renal biosies 12. Tonsil and adenoids

13. Sentinel lymph nodes and all regional lymph node dissections

14. Stomach resection 15. Spleen 16. Bladder resection and bladder

biopsies 17. Brain removal, biopsies 18. Liver resection and liver biopsies 19. Mastectomies, lumpectomies, and

breast core biopsies 20. Limb amputation as well as fingers

and toes 21. Lung including biopsies, lobectomies

and pneumonectomies 22. Pancreas

PROCESSING EXAMINATION

May be performed by Histology supervisor, Lead Histothecnologist, and Histotechnologist that has national certification with ASCP HT or HTL and met

the minimum training/experience required by having an earned associated degree in a laboratory science or medical laboratory technology…are

approved to provide (processing) examination of the following specimens with the indirect supervision by a Pathology or Pathologists’ Assistant:

1. All skin biopsies except those requiring margins

2. All biopsies including EMC’s, ECC’s, cervical (except cones), liver, bladder, vaginal, kidney, lung, bone marrow, stereotactic breast, gastrointestinal and clots

3. Muscle biopsies

4. FNA specimen

• Jeffrey A.R. et al . : Colorectal Surgical Specimen Lymph Node Yield with a Pathology Assistant. J.Gastrointestinal Surg.2009

• Colleen O.G. et al. :Pathologist Assistance Practice. A measurement of performance. American Journal Clinical Patholoy 2001

• John Vitale, Reed Brooks, Michael Sovocool,W. Rae Rader: ValueAdded Benefits and Utilization af Pathologists’ Assistants

PERFORMANCE DEL PA’s

IMPATTO SULL’EFFICIENZA E LA QUALITA’ IN LABORATORIO

PATHOLOGISTS’ ASSISTANT

PATHOLOGISTS’ ASSISTANT

• E’ UN PROFESSIONISTA ALTAMENTE SPECIALIZZATO CHE ESPLETA SVARIATI SERVIZI CON LA SUPERVISIONE DEL PATOLOGO.

• E’PRESENTE DA DECENNI NEI LABORATORI DI ISTOPATOLOGIA DI USA E CANADA.

• IL SUO RUOLO SI ESTENDE ANCHE ALL’AREA AMMINISTRATIVA, GESTIONALE E ALLA FORMAZIONE.

TECNICI DI ISTOPATOLOGIA

Il Tecnico di Istopatologia può descrivere e campionare le seguenti biopsie:

1. Biopsie del tratto gastrointestinale

2. Agobiopsie epatiche, renali,prostatiche,

mammarie

3. Biopsie endometriali e ginecologiche,

TURP E TURV

4. BOM

5. Per la patologia cutanea è consigliabile sempre che sia presente un patologo

QUALI SONO LE PROBLEMATICHE DI UN SERVIZIO DI ANATOMIA PATOLOGICA?

• Processi prevalentemente artigianali

• Poca automazione

• Sistemi di lavoro complicati e difficili da standardizzare

• Necessità di più personale rispetto alla media degli altri servizi

• Richiesta di esperienza e specializzazione dei profili professionali

• Tempi più lunghi per la formazione del personale

QUALI SONO LE PROBLEMATICHE DI UN SERVIZIO DI ANATOMIA PATOLOGICA?

• Irripetibilità di campionamento

• Problemi medico-legali legati all’errore diagnostico

• Continua informazione e formazione sulle nuove tecnologie e metodiche

• Settori specialistici e diagnostici

• Elevata richiesta di aspettativa da parte del cliente

• TAT

• COSTI

…E IN ITALIA?

Quale possibile modello di formazione per il PA’s in Italia?

• Master di formazione dopo laurea triennale in tecniche di laboratorio ?

• Percorso universitario separato dalla laurea triennale in tecniche di laboratorio ?

• Laurea specialistica per tecnici di laboratorio?

QUALE FUTURO? .