Management & Operations

Canadian Hospital Laboratories are "Unraveling at the Seams"

Dramatic headlines in Canada last week described the nation's clinical and pathology laboratories as "unraveling at the seams," with the President of the Canadian Association of Pathologists noting that laboratories in that country face a "host of problems," ranging from increasingly complex medical tests and growing demands for faster results to a critical shortage of pathologists and lab workers.

Association President Jagdish Butany, MBBS, MS, writing in an editorial published in the Canadian Medical Association Journal (CMAJ)  this month, noted that "All of these factors have overwhelmed the pathology laboratory." Along with co-author Kathy Chorneyko, M.D., Assistant Medical Director Laboratory Services, Brant Community Healthcare System, Brantford, Ontario, Butany was calling on the nation's healthcare system to devote more resources to laboratory medicine and take steps to implement mandatory laboratory accreditation and proficiency testing in all provinces.

Butany and Chorneyko were responding to a series of failures by laboratory organizations and individual pathologists in Canada that got wide publicity in recent months. Butany and Chorneyko wrote that: "Critical issues in Canadian anatomic pathology have surfaced like a crashing wave. Reports from the judicial inquiry into erroneous breast cancer estrogen and progesterone receptor testing, the public inquiry into faulty forensic pathology, investigations into pathology misdiagnoses in New Brunswick, and, most recently, a pathologist's high error rate in Owen Sound, Ontario, have occupied the minds of Canadian pathologists for months and eroded public confidence."

These problems in pathology are what prompted the call for a national quality-assurance program that could include proficiency testing and quality assessment. Pathologists in Canada struggle with many of the same workforce issues that pathologists face in the United States. But Canada does not have a national quality-assurance program for clinical pathology such as found in other developed countries.

"Canadian laboratories are not unique in facing workload and human-resource issues or problems pertaining to medical error and patient safety. However, they are unique in that they lack a national quality-assurance program such as exists within the College of American Pathologists, the British Royal College of Pathologists and the Royal College of Pathologists of Australasia," wrote the two pathologists. They outlined three steps Canada should take:

1) "First, urgent attention is needed to address the serious human-resource issues to alleviate staffing problems and improve future laboratory performance

2) "Second, local hospital administrations and provincial ministries of health should immediately fund quality-assurance efforts in the laboratory system.

3) "Third, we must create an appropriately resourced national body to promote excellence in the practice of laboratory medicine in Canada. Such an organization, similar to others around the world, would link together existing provincial laboratory accreditation programs and provide quality assurance to other regions. It could also set national standards and guidelines, establish voluntary professional proficiency quality assurance, coordinate educational activities, and advise and guide human-resource planning."

In Canada, one way to interpret the failure of individual pathologists and the breakdowns in test result integrity and quality is that years of inadequate investment are starting to show up in discoveries of lab test failures and instances of poor pathologist performance that trigger headlines in newspapers and television news broadcasts. Canada is seeing the consequences of this inadequate investment. An overstretched laboratory infrastructure, coupled with the lack of an adequate inflow of newly-trained pathologists and technical laboratory staff, makes it challenging for overstretched laboratory personnel to accommodate steady growth in testing volume and more complex laboratory test procedures. Because Canada lacks a rigorous national/provincial program for laboratory accreditation and proficiency testing, it lacks the ability to detect potential or actual failures in laboratory testing services in a timely and proactive manner.

Dark Daily observes that one of the attributes of single-payer, government-run national health systems is the tendency to under-invest in the component sectors of the healthcare community, compared to the level of investment that occurs in the United States, with our mixed public/private healthcare system. Thus, as utilization of laboratory tests and anatomic pathology services increases in Canada, their national health system pushes up against a resource ceiling in laboratory testing. The meager, year-to-year increase in the supply of pathologists is recognized to fall short of increased demand for testing. The impending retirement of as many as half the nation's trained technical laboratory staff has yet to be effectively addressed.

Related articles:

Pathologists call on governments to remedy problems at overworked labs

Canada's pathology