Difference between revisions of "Quality"

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(IHC classes)
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==Biopsy size==
==Biopsy size==
Very small tissue fragments are associated with a decreased diagnostic yield and an increased diagnostic uncertainty.
Very small tissue fragments are associated with a decreased diagnostic yield and an increased diagnostic uncertainty.
==Immunohistochemistry==
A paper by Torlakovic ''et al.''<ref name=pmid20154273>{{Cite journal  | last1 = Torlakovic | first1 = EE. | last2 = Riddell | first2 = R. | last3 = Banerjee | first3 = D. | last4 = El-Zimaity | first4 = H. | last5 = Pilavdzic | first5 = D. | last6 = Dawe | first6 = P. | last7 = Magliocco | first7 = A. | last8 = Barnes | first8 = P. | last9 = Berendt | first9 = R. | title = Canadian Association of Pathologists-Association canadienne des pathologistes National Standards Committee/Immunohistochemistry: best practice recommendations for standardization of immunohistochemistry tests. | journal = Am J Clin Pathol | volume = 133 | issue = 3 | pages = 354-65 | month = Mar | year = 2010 | doi = 10.1309/AJCPDYZ1XMF4HJWK | PMID = 20154273 }}</ref> divides IHC tests into:
*''Class I'':
**Adjunct to histomorphology.
**Example: CD45, S-100.
*''Class II'' - used directly for treatment decisions; it is considered independent of the other information in the pathology report.
**ER, PR, HER2.


==See also==
==See also==

Revision as of 01:50, 18 January 2012

Quality, in pathology, has got a lot of attention lately because there have been high profile screw-ups that lead to significant harm.[1]

Analysis

Quality issues are examined a number of different ways, e.g. root cause analysis, failure mode and effects analysis (FMEA).

A common way to break down error analysis is:

 
 
 
 
 
 
 
 
Errors in pathology
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Pre-analytical errors
 
 
Analytical errors
 
 
Post-analytical errors

Error reduction

Various strategies can be employed:[2]

  • Training of staff - on error handling.
  • Computer order entry.
    • Avoid duplication fatigue.
    • Quick correlation with several identifying features.
      • Full name, sex, date of birth -- these all appear when one opens a case.
  • Barcode use.
    • Avoid transcription errors.
  • Clinical information entry required.
    • Allow correlation with test.
      • The interpretation may differ if the history says "screening coloscopy" versus "large cecal mass, anemia and weight loss".

Other strategies:

  • Statistical process control.

Sources of error

  • "Human error".
    • Training.
    • Work flow.
  • Process gaps.
    • Process control.
    • Lack of redundancy.

Biopsy size

Very small tissue fragments are associated with a decreased diagnostic yield and an increased diagnostic uncertainty.

Immunohistochemistry

A paper by Torlakovic et al.[3] divides IHC tests into:

  • Class I:
    • Adjunct to histomorphology.
    • Example: CD45, S-100.
  • Class II - used directly for treatment decisions; it is considered independent of the other information in the pathology report.
    • ER, PR, HER2.

See also

References

  1. URL: http://www.attorneygeneral.jus.gov.on.ca/inquiries/goudge/index.html. Accessed on: 1 March 2011.
  2. Fabbretti, G. (Jun 2010). "Risk management: correct patient and specimen identification in a surgical pathology laboratory. The experience of Infermi Hospital, Rimini, Italy.". Pathologica 102 (3): 96-101. PMID 21171512.
  3. Torlakovic, EE.; Riddell, R.; Banerjee, D.; El-Zimaity, H.; Pilavdzic, D.; Dawe, P.; Magliocco, A.; Barnes, P. et al. (Mar 2010). "Canadian Association of Pathologists-Association canadienne des pathologistes National Standards Committee/Immunohistochemistry: best practice recommendations for standardization of immunohistochemistry tests.". Am J Clin Pathol 133 (3): 354-65. doi:10.1309/AJCPDYZ1XMF4HJWK. PMID 20154273.