The Cytopathology Laboratory at Hospital da Mulher - Caism, at Unicamp, has just been accredited by the Ministry of Health as a type II laboratory. With this, he will be reaching a new level in his offerings. You must do the external quality monitoring of laboratories that provide type 1 services to the State of São Paulo, which are those that evaluate cytopathological tests for the detection of cervical cancer, known as pap smears.
The State proposed to Caism a monitoring of 60 thousand exams per year. In this way, hewill be the largest auditor among laboratories in this area, followed by the Oncocentro de São Paulo Foundation (Fosp) and the Adolfo Lutz Institute. The State's strategy is to continually improve the standard of exams offered to the population through external monitoring.
Caism previously worked with type I laboratories, carrying out cytopathological tests in Campinas and more than 65 municipalities in the network. According to Fabiana Casellato, supervisor of Caism's Cytopathology Laboratory, the laboratory produced 20 slides per month. “The patient went to the health center to get a pap smear. The slides and exam requests were sent to Caism, where we carried out the reading and diagnosis.”
Now, the State intends to create a triad in which Caism, Fosp and Adolfo Lutz, the last two from the city of São Paulo, will have similar skills and abilities. But Caism must continue doing the approximately one thousand monthly type I exams for himself, and the breast exams he already did every month (around 120), plus the five thousand exams per month proposed by the State.
Fabiana mentions that, with the change and certification to QualiCito II (National Qualification in Cytopathology), the QualiCito I exams will be carried out by the Barretos Cancer Hospital. As a result, Caism's consultancy will be focused on quality and quality monitoring.
Caism, she highlights, will carry out the largest number of tests due to the number of employees it has, the infrastructure and the prestige of the laboratory, which is completing 50 years and which, until now, carried out around 250 thousand tests per year. "This certification is believed to result from the care the hospital provides at the tertiary level and its cutting-edge research."
Project
To obtain this qualification from the Ministry of Health, the laboratory team had to produce a project, be qualified, establish goals and develop a type of strategic planning. “We had to comply with items such as having a positivity rate above 3%, serving a region with more than 15 thousand annual tests, having internal quality monitoring, etc. These aspects are also verified by the National Health Surveillance Agency (Anvisa)”, says Fabiana.
She also comments that it took nine months to obtain this accreditation. In October 2017, Caism received the last type I blade and should begin work on type II this semester.
Every month, the laboratory will receive funding from the Costing Block for Public Health Actions and Services for the five thousand slides that it will evaluate from laboratories selected by the State Department of Health (SES). “We will have another dynamic, as we will evaluate the quality of cytopathological examinations of the cervix from public and private laboratories that provide services to the Unified Health System (SUS). It will be a benefit for the population and for the State, to better monitor its service providers”, he highlights.
The intention of external monitoring is not to criticize or subdue, but rather to maintain the quality of the type I laboratory, advise it, encourage it and add new values to it, with the support of the 19 employees of the Caism laboratory, who have worked at the hospital for at least 15 years. “We believe that carrying out an audit with professionals of this experience and capacity can greatly collaborate with the State”, emphasizes the laboratory supervisor.
Technology
According to André Aparecido da Silva, supervisor of the laboratory's administrative area, in addition to providing the service to the State, Caism will offer training to other laboratories as needed. At this moment, professionals are undergoing weekly continuing education meetings, designed to standardize cytological criteria and update QualiCito terminology.
André reveals that the Cytopathology Laboratory will soon be acquiring new computers and more sophisticated capture microscopes, as until now cytologists only read the slides. Now they will read and insert the reports into the system, in addition to capturing images to discuss cases. In addition to the technicians, the Caism Cytopathology Laboratory has higher-level cytologists and doctors, which gives even greater accuracy to the exams.
Qualicito's mission is to prevent cervical cancer, providing direct service to health units, and reduce the percentage of false-negative tests. With this monitoring, it will be possible to reduce the occurrence of errors in the diagnosis of cervical cancer.
