A dying breed of elves
The engine of the department is that section to which hundreds of tissue-filled cassettes are sent every day, i.e. the histopathology laboratory. The individuals who cut and stain biopsies are called histotechnologists. Their laboratory is, to some degree, automated, but enough humans must be present to supervise and monitor the machines, none of which exercises dependable judgment or discretion. When a histopathology laboratory operates with a minimal staff, the unexpected absence of only one person easily maims the production line, leading to a backlog that interferes with clinical treatment. Since everyone is entitled to a vacation, and because illnesses are unplanned, most laboratories might be “completely” staffed for only portions of the year.
There is probably no part of the biopsy life cycle that is as closely monitored for error as in the histopathology laboratory, where a detailed account of every batch of work is maintained. Quality controls in this area are meant to guarantee the correct identity of every specimen transferred from paraffin block to glass slide, as well as to ensure the correct labeling of the slides themselves. Histotechnologists are trained to spot and eliminate discrepancies, preventing errors from reaching the pathologist. Each tissue block, once cut, is sent to storage, where it is kept for many years. Histotechs are under constant pressure to cut as many blocks as possible, but maximum daily limits are set by The College of American Pathologists. In an environment through which thousands of specimens pass every year, and notwithstanding an almost maniacal obsession with checks and cross checks, it is impossible to avoid a very low baseline level of error. The problem may be an incorrectly numbered cassette, a switched cassette, a cassette in which the tissue has been improperly processed, or a mislabeled slide. Experienced histotechnologists are almost always able to recognize and resolve these issues.
The country’s population of histotechnologists is an endangered species. These workers are harder and harder to find and difficult to create. Experienced, fast-working and dedicated histotechs are valuable and indispensable assets, but as a group, they are aging. Few formal histotechnology schools exist in the nation, and are insufficient for current and future needs. We pay close attention to projected shortages of physicians and nurses, yet ignore the dwindling supply of technologists who provide essential support for clinical services. It is extremely worrisome that the number of people entering histotechnology is diminishing. The vacancy rate in the discipline reportedly approaches 25% in parts of the country, so that one in every four histotechnology practitioner positions remains unfilled, a cause for deep worry. A further concern is that histotechnologists often do more than one job during 24 hours. This is something impossible to monitor or even control, but it is worrisome that some histotechs commence a daytime shift in continuity with an overnight job at a different institution.