PATOLOGISTS` ASSISTANT: alta formazione e management in

PATHOLOGISTS’ ASSISTANT:
alta formazione e management
in anatomia patologica
VI Congresso Nazionale FITeLab - VERONA
Chiara Arzenton
LA SFIDA
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SCARSITA’ DI RISORSE
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INNOVAZIONE
TECNOLOGICA
APPROPRIATEZZA
PRESTAZIONI
EFFICIENZA
MUTAMENTI ORGANIZZATIVI
STRUTTURA
CULTURA
PROFESSIONALITA’
TECNICO DI LABORATORIO:
sviluppo formativo e professionale
1.
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6.
DM 745/1994: profilo professionale.
L 42/1999: TLB come professionista sanitario.
DM 3/11/1999 n 509 (Riforma Universitaria)e DMURST 5/6/2001
L 251/2000: autonomia professionale.
L 1/2002: accesso diretto a Laurea Specialistica e Master.
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
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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
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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
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14.
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22.
Sentinel lymph nodes and all regional
lymph node dissections
Stomach resection
Spleen
Bladder resection and bladder
biopsies
Brain removal, biopsies
Liver resection and liver biopsies
Mastectomies, lumpectomies, and
breast core biopsies
Limb amputation as well as fingers
and toes
Lung including biopsies, lobectomies
and pneumonectomies
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.
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All skin biopsies except those requiring margins
All biopsies including EMC’s, ECC’s, cervical (except cones), liver, bladder,
vaginal, kidney, lung, bone marrow, stereotactic breast, gastrointestinal
and clots
Muscle biopsies
FNA specimen
PATHOLOGISTS’ ASSISTANT
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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
• 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?
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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?
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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?