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Difference between revisions of "Quality"
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*Grade 1: no consequence. | *Grade 1: no consequence. | ||
*Grade 2: possible consequence. | *Grade 2: possible consequence. | ||
*Grade 3: definitely a | *Grade 3: definitely a consequence. | ||
==Error reduction== | ==Error reduction== | ||
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**Allow correlation with test. | **Allow correlation with test. | ||
***The interpretation may differ if the history says "screening coloscopy" versus "large cecal mass, anemia and weight loss" versus "breast cancer". | ***The interpretation may differ if the history says "screening coloscopy" versus "large cecal mass, anemia and weight loss" versus "breast cancer". | ||
*The use of algorithms to guide decisions where applicable.<ref>Kahneman D. ["Als wären wir gespalten": Der Psychologe und Nobelpreisträger Daniel Kahneman über die angeborenen Schwächen des Denkens, trügerische Erinnerungen und die irreführende Macht der Intuition]. Der Spiegel. Nr. 21. 2012. URL: [http://www.spiegel.de/spiegel/print/index-2012-21.html http://www.spiegel.de/spiegel/print/index-2012-21.html].</ref> | |||
**Remove subjectivity. | |||
**Increase objectivity, reproducibility. | |||
==Dealing with diagnostic errors== | |||
* | *Reports that have a diagnostic error should be ''[[Amendment|amended]]''. | ||
*If an addendum would add information to the report that contradicts other information already in the report: it should be an amendment (not an addendum).<ref name=pmid25357114>{{cite journal |authors=Babwah JP, Khalifa M, Rowsell C |title=Analysis of addenda in anatomic pathology as a quality monitoring initiative |journal=Arch Pathol Lab Med |volume=138 |issue=11 |pages=1514–9 |date=November 2014 |pmid=25357114 |doi=10.5858/arpa.2012-0412-OA |url=}}</ref> | |||
It is good practice when amending an report to: | |||
* Clearly state the revised diagnosis. | |||
* Clearly note that the diagnosis was changed. | |||
* Clearly state what the diagnosis was previously. ‡ | |||
* Have another pathologist confirm the revised diagnosis. | |||
* Communicate directly with the most responsible physician - make them aware of the change. | |||
* Document the communication. | |||
‡ It should be noted that: most modern electronic records track all changes. This tracking may or may not be apparent to the end user. Generally, old versions of a report are retrievable. It is good practice to be transparent about a change. | |||
=Measures of quality= | =Measures of quality= | ||
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#Counterstaining. | #Counterstaining. | ||
#Interpretation problem. | #Interpretation problem. | ||
#*Known/expected epitope cross-reactions, e.g. CMV & HSV.<ref name=pmid3029407>{{Cite journal | last1 = Balachandran | first1 = N. | last2 = Oba | first2 = DE. | last3 = Hutt-Fletcher | first3 = LM. | title = Antigenic cross-reactions among herpes simplex virus types 1 and 2, Epstein-Barr virus, and cytomegalovirus. | journal = J Virol | volume = 61 | issue = 4 | pages = 1125-35 | month = Apr | year = 1987 | doi = | PMID = 3029407 | PMC = 254073 | | #*Known/expected epitope cross-reactions, e.g. [[CMV]] & [[HSV]].<ref name=pmid3029407>{{Cite journal | last1 = Balachandran | first1 = N. | last2 = Oba | first2 = DE. | last3 = Hutt-Fletcher | first3 = LM. | title = Antigenic cross-reactions among herpes simplex virus types 1 and 2, Epstein-Barr virus, and cytomegalovirus. | journal = J Virol | volume = 61 | issue = 4 | pages = 1125-35 | month = Apr | year = 1987 | doi = | PMID = 3029407 | PMC = 254073 | | ||
URL = http://www.ncbi.nlm.nih.gov/pmc/articles/PMC254073/?tool=pubmed }}</ref> | URL = http://www.ncbi.nlm.nih.gov/pmc/articles/PMC254073/?tool=pubmed }}</ref> | ||
#*Unknown/unexpected epitope cross-reactions. | #*Unknown/unexpected epitope cross-reactions. | ||
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==Data retention standards== | ==Data retention standards== | ||
*There are data retention standards - how long results have to be retained. | *There are data retention standards - how long results have to be retained. | ||
===College of American Pathologists=== | |||
*In the United States, there are standards from ''College of American Pathologists'' (CAP) and ''Clinical Laboratory Improvement Amendments'' (CLIA).<ref>URL: [http://www.cms.gov/clia/ http://www.cms.gov/clia/]. Accessed on: 1 April 2012.</ref> | *In the United States, there are standards from ''College of American Pathologists'' (CAP) and ''Clinical Laboratory Improvement Amendments'' (CLIA).<ref>URL: [http://www.cms.gov/clia/ http://www.cms.gov/clia/]. Accessed on: 1 April 2012.</ref> | ||
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*Fine needle aspiration: 10 years from the exam date. | *Fine needle aspiration: 10 years from the exam date. | ||
*Histopathology slides: 10 years from the exam date. | *Histopathology slides: 10 years from the exam date. | ||
===Canadian Association of Pathologists=== | |||
The Canadian standards are higher than the US ones. | |||
Summary of selected suggestions:<ref>URL: [http://cap-acp.org/guide_retention-human-biologic-material.cfm http://cap-acp.org/guide_retention-human-biologic-material.cfm]. Accessed on: 6 May 2012.</ref> | |||
{| class = "wikitable sortable" | |||
! Material | |||
! Origin | |||
! Suggested retention period | |||
! Additional notes | |||
|- | |||
| Wet tissue | |||
| surgical | |||
| 4 weeks after final report | |||
| - | |||
|- | |||
| Paraffin blocks | |||
| surgical | |||
| 20 years | |||
| 50 years for paediatric cases | |||
|- | |||
| Slides | |||
| surgical | |||
| 20 years | |||
| - | |||
|- | |||
| Wet tissue | |||
| autopsy | |||
| 3 months after final report | |||
| Coroners'/medical examiner cases may be longer | |||
|- | |||
| Paraffin blocks | |||
| autopsy | |||
| 10 years | |||
| Coroners'/medical examiner cases may be longer | |||
|- | |||
| Slides | |||
| autopsy | |||
| 10 years | |||
| Coroners'/medical examiner cases may be longer | |||
|- | |||
|} | |||
==Failure-potential analysis== | ==Failure-potential analysis== | ||
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Note: | Note: | ||
*Unfortunately one has to shell | *Unfortunately one has to shell out money to get a peak at 'em. | ||
==United States of America== | ==United States of America== | ||
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*Do laboratory accreditation.<ref>URL: [http://www.cap.org/apps/cap.portal?_nfpb=true&cntvwrPtlt_actionOverride=%2Fportlets%2FcontentViewer%2Fshow&_windowLabel=cntvwrPtlt&cntvwrPtlt{actionForm.contentReference}=laboratory_accreditation%2Faboutlap.html&_state=maximized&_pageLabel=cntvwr http://www.cap.org/apps/cap.portal?_nfpb=true&cntvwrPtlt_actionOverride=%2Fportlets%2FcontentViewer%2Fshow&_windowLabel=cntvwrPtlt&cntvwrPtlt{actionForm.contentReference}=laboratory_accreditation%2Faboutlap.html&_state=maximized&_pageLabel=cntvwr]. Accessed on: 18 April 2012.</ref> | *Do laboratory accreditation.<ref>URL: [http://www.cap.org/apps/cap.portal?_nfpb=true&cntvwrPtlt_actionOverride=%2Fportlets%2FcontentViewer%2Fshow&_windowLabel=cntvwrPtlt&cntvwrPtlt{actionForm.contentReference}=laboratory_accreditation%2Faboutlap.html&_state=maximized&_pageLabel=cntvwr http://www.cap.org/apps/cap.portal?_nfpb=true&cntvwrPtlt_actionOverride=%2Fportlets%2FcontentViewer%2Fshow&_windowLabel=cntvwrPtlt&cntvwrPtlt{actionForm.contentReference}=laboratory_accreditation%2Faboutlap.html&_state=maximized&_pageLabel=cntvwr]. Accessed on: 18 April 2012.</ref> | ||
=== | ==Canada== | ||
===Canadian immunohistochemistry quality control=== | |||
*Quality Management Program - Laboratory Services | *Abbreviated ''CIQC''. | ||
*[https://ciqc.ca/Pages/default.aspx CIQC webpage (ciqc.ca)] | |||
===Ontario=== | |||
*[[Institute for Quality Management in Healthcare]] - previously ''Quality Management Program - Laboratory Services''. | |||
**Set-up by the ''Ontario Medical Assocation''. | **Set-up by the ''Ontario Medical Assocation''. | ||
==United Kingdom== | |||
* | *National Pathology Benchmarking Service (NPBS).<ref>URL: [http://www.keele.ac.uk/pharmacy/general/npbs/ http://www.keele.ac.uk/pharmacy/general/npbs/]. Accessed on: 18 April 2012.</ref> | ||
=See also= | =See also= | ||
*[[Critical values]]. | *[[Critical values]]. | ||
*[[CAP checklists]]. | *[[CAP checklists]]. | ||
*[[Tissue floater]]. | |||
*[[Histology artifacts]]. | |||
*[[Waffle diagnosis]]. | |||
*[[Workload measurement]]. | |||
*[[Anatomical pathology laboratory processes]]. | |||
=References= | =References= | ||