Beyond counting errors: clinical pathway-specific preanalytical risk profiles in surgical pathology

This is the authors' abstract. We don't add key points for this paper.

To determine whether clinical referral pathways exhibit distinct preanalytical risk profiles that could complement conventional laboratory-wide quality assessment in surgical pathology. We conducted a retrospective observational study of prospectively recorded preanalytical non-conformities in a tertiary academic pathology department between 2019 and 2024. Pathology requests underwent systematic conformity assessment at reception and were classified into predefined clinical referral pathways according to specimen acquisition workflow. Non-conformity incidence per 1,000 requests was analysed using negative binomial regression, and pathway-specific profiles were explored by hierarchical clustering. Among 68,274 pathology requests analysed over five complete years, 10,421 (15.3%) presented at least one preanalytical non-conformity, corresponding to 14,205 events. Overall incidence decreased from 203.0 to 79.0 non-conforming requests per 1,000 requests between 2019 and 2024. Marked differences persisted across clinical referral pathways. Compared with specialty outpatient clinics, adjusted incidence rate ratios were highest for image-guided procedures (5.40), operating room specimens (4.12), gynaecology and obstetrics (3.95), and medical wards (2.26). Hierarchical clustering identified distinct pathway-specific patterns of documentation, specimen handling and identification-related non-conformities. Preanalytical risk is not uniformly distributed across surgical pathology workflows but follows distinct clinical referral pathway-specific profiles. Incorporating pathway-specific analyses into routine quality assessment may complement conventional laboratory-wide indicators and support more targeted quality improvement strategies.