Quality

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

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:

• 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. 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

• Critical values.
• CAP checklists.