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Difference between revisions of "Quality"
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→Error analysis
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#Identify the corrective action. | #Identify the corrective action. | ||
=== | ===General error analysis=== | ||
*Pathology errors happen any time from when the lab gets the specimen until after the report is | *Pathology errors happen any time from when the lab gets the specimen until after the report is issued. | ||
When errors happen: | When errors happen: | ||
*Work-up problem | *Work-up problem. | ||
*Talk to | **Where did it occur? | ||
*Talk to chief of pathology. | *Talk to the clinician. | ||
**If it is a ''[[critical diagnosis]]'' contact most-responsible physician immediately... if they are unreachable call physician on-call for the most-responsible physician. | |||
*Talk to the chief of pathology. | |||
*Incident report. | *Incident report. | ||
*Reconstruct error. | *Reconstruct error. | ||
** | **Was it a specimen mix-up? | ||
***Is there another error? | |||
*Amend report(s). | *Amend report(s). | ||
*Remedy source of error. | *Remedy source of error. | ||
Pre-analytic | ====Pre-analytic errors==== | ||
*Container mix-up - pre-lab & in-lab. | *Container mix-up - pre-lab & in-lab. | ||
*Block mix-up. | *Block mix-up. | ||
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*Poor quality slides (fixation, processing, staining). | *Poor quality slides (fixation, processing, staining). | ||
Analytic | ====Analytic errors==== | ||
*Interpretation wrong. | *Interpretation wrong. | ||
**Difficult case. | **Difficult case. | ||
**Technical factors (quality of slides). | **Technical factors (quality of slides). | ||
Post-analytic | ====Post-analytic errors==== | ||
*Wrong case signed-out. | *Wrong case signed-out. | ||
*Filing problem. | *Filing problem. | ||
*Interpretation of report problem (poorly written, bad interpretation). | *Interpretation of report problem (poorly written, bad interpretation). | ||
===IHC problems=== | |||
Work-up of suspected IHC problems: | |||
*Review controls (internal and external). | |||
**Isolated to case vs. larger problem? | |||
***Discuss with lab/make other pathologists of the issue. | |||
*Repeat test - to identify the cause. | |||
==Error reduction== | ==Error reduction== | ||