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Efforts By Andrea Barbieri, MD, and Kristen Tupay Highlight Continuous Focus on Safety at Yale Pathology

February 14, 2022

Two recent efforts by Yale Pathology Department professionals highlight the continuous focus on patient and staff safety at Yale Pathology and within the Yale New Haven Hospital System (YNHHS).

The first instance happened last spring when Andrea Barbieri, MD, mostly likely saved a patient from unnecessary surgery and surgical loss of her colon by determining that an outside pathology specimen contained a non-patient contaminating tissue, known as a floater, which led to a clinically significant difference in the diagnosis.

The second instance took place February 1 when Kristen Tupay, a Pathology Morgue and Autopsy Technician, took actions that mitigated COVID exposure to attending physicians, pathology residents, and autopsy staff members.

In Dr. Barbieri’s case, a female patient, age 59, was referred to Yale Medicine Digestive Health for a diagnosis of dysplasia in the setting of inflammatory bowel disease rendered after a screening colonoscopy performed outside the YNHHS. Under YNHHS regulations, significant pathology diagnoses from referring hospitals must be re-reviewed by Yale Pathology before any treatment or further visits.

Dr. Barbieri reviewed the slides in Yale Pathology and, after careful consideration, suspected that the presence of dysplastic tissue was “tissue contamination or tissue floaters,” meaning contamination of tissue between lab cases.

Although this known lab error has led to patient harm in the past, recent work throughout the YNHHS has focused on risk assessments and proactive laboratory procedures for the detection and prevention of floaters.

DNA testing performed at Yale Pathology on the dysplastic tissue confirmed it was tissue contamination/tissue floater, and the correct diagnosis of negative for dysplasia was made. Yale Pathology shared its report with the outside laboratory, which concurred with Dr. Barbieri’s diagnosis.

Dr. Barbieri’s effort spared this patient unnecessary surgery and reinforced the importance of YNHHS regulations to re-review significant pathology diagnoses from referring hospitals.

In Ms. Tupay’s case, she was present when the Pathology morgue staff received a deceased patient from Bridgeport Hospital for an autopsy at the YNHH York Street Campus. York Street Pathology performs most autopsies for the other YNHHS Delivery Networks.

While reviewing the patient’s chart in preparation for autopsy, Ms. Tupay recognized that the patient’s symptoms aligned with COVID symptoms; however, prior COVID tests were negative, and the patient had been fully vaccinated. Amid the high Omicron variant transmissibility, Ms. Tupay raised her concerns and, under advice of the autopsy director, performed a COVID test on the patient, which came back positive.

The autopsy was then prepared according to the YNHHS specialized COVID autopsy standard operating procedure, which differs vastly from a non-COVID patient autopsy and ensures autopsy staff safety by minimizing infection risk. Ms. Tupay’s actions reduced the possibility of COVID exposure to attending physicians, pathology residents, and autopsy staff.

For their actions, they were both recognized with Great Catch Awards for contributing to quality and safety, Dr. Barbieri at YNHHS and Ms. Tupay at Yale Pathology. Great Catch Awards recognize the most impactful safety stories in which an individual identifies and stops an error from reaching a critical point.

Submitted by Terence P. Corcoran on February 14, 2022