Quality
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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".
- Allow correlation with test.
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
- ↑ URL: http://www.attorneygeneral.jus.gov.on.ca/inquiries/goudge/index.html. Accessed on: 1 March 2011.
- ↑ 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.
- ↑ 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.