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quality control in surgical pathology
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quality control in surgical pathology

These  and other equipment  should  be of standard  quality and calibrated at periodic intervals. Usage of controls for routine and special stains daily as a routine  is strongly  recommended. Arch Pathol Lab Med 2006;130:630-32. External quality assessment in histopathology to NABL accredited laboratories in India, with the long-term  goal of including  non  accredited laboratories into the programme is the goal. It varies with the skill and experience of the  technician. Leukocytes and RBCs utilize glucose and cause a steady decrease in the concentration of glucose. Association of Directors of Anatomic and Surgical Pathology. Examination aspects include studying the slides along with relevant data and additional information,  and preparation  of the report with diagnosis. The requisition form should include patient demographic data, nature and site of specimen, clinical diagnosis, all relevant clinical, investigative and intraoperative findings. Evaluation of turnaround times as a component of quality assurance in surgical pathology. Misinterpretation  may occur due to inadequate specimen, non  representative  specimen  and incomplete clinical data. COVID-19 is an emerging, rapidly evolving situation. Quality Control Of Surgical Pathology Services By Dr.Amal Abd El Hafez Lecturer Of Pathology Faculty Of Medicine Mansoura University By Dr.Amal Abd El Hafez Le… Disclosing medical errors not only maintains respect for patient autonomy and … Most have used the term addendum to report this change. Each one involved in  Pathology  reporting should be aware of one’s responsibilities and the medico legal repercussions if any, of the actions. Dahl J. USA.gov. The ideal system has the ability to pull together all the components of surgical pathology with integrated quality assurance and quality control checks. Essentials of Anatomic Pathology, 3rd Ed, Springer Science+Business Media, LLC 2011, 481-7. [2,11], QC in Immunohistochemical analysis include checks for frequency and causes of repeated stains; turnaround   time  (TAT) issues; audit  for issues regarding integration of stains with morphologic diagnosis; annual  review of antibody  inventory and  frequency of use  and  consideration  of enrolment in external proficiency testing particularly for tests that  directly affect patient therapy, such as HER-2/neu immunostaining. Quality assessment of intraoperative frozen sections: An analysis of 261 consecutive cases in a resource limited area: Morocco. Canadian immunohistochemistry quality control. Todaysclinician.com © 2017 | Teach Learn Build. 2006 Aug. 37(8):985-8. . It should be available at the workplace and all technical staff should be aware of its contents. In: Cheng L, Bostwick DG (eds.). Quality improvement projects are ongoing throughout all areas of the laboratory that support the MOVERS quality vision of UCLA Health. Julia Dahl, MD. Assign, review, and edit SNOMED codes. Coding Verify the accuracy and editing of CPT codes. All the diagnoses received within the notified period are analyzed and a consensus diagnosis is given. Recommendations for Quality Assurance and Improvement in Surgical and Autopsy Pathology. To investigate the state of quality control in surgical pathology in Japan, we conducted a questionnaire survey of 80 pathology departments in universities and 275 laboratories in hospitals that are officially accredited by the Japanese Society of Pathology(JSC). C linical laboratory tests and anatomic pathology diagnoses affect the vast majority of treatment decisions made by clinical physicians in nearly every medical discipline, impacting nearly every person seeking medical care. [2,3], Care should be taken not to induce tissue artefacts due to improper processing, sectioning, staining and mounting. • Frequency – Daily • Evaluate the problem and fill the feedback from specifying the problem. Results of a cooperative educational program to improve prostate pathology reports among patients undergoing radical prostatectomy. National Pathology Benchmarking Service (NPBS). The quality of our work is continuously monitored by internal and external quality control programs, and we participate in both routine proficiency testing and hospital-wide quality improvement programs. The practice of Surgical Pathology is prone to human error and there should be a constant endeavor to minimize this error to provide the patients with the highest standard of care. The knife should be properly maintained. These  are either  prohibitively expensive or  not easily available in India. [15] Many institutions include some type of grading scheme to determine what harm or potential harm may result from an error such as No harm or impact on patient care, slight harm or impact on patient care, significant harm or alteration of clinical management.[4-6]. Some have used the term corrected report for this change. Many technical and procedural quality control items are covered elsewhere in this Checklist.They are integral components of comprehensive quality management and should be included within the defined program.This section determines if there is an active program of surveillance of the quality of surgical pathology activities, Quality Control in Histopathology. These include the Pre-examination (pre-analytical) phase which includes all processes for generation of a good Examination  (analytical)  phase which is the interpretation  of slides and making an accurate diagnosis, and  the  Post-examination  (post- analytical)  phase  which includes  the  proper dispatching of result, storage/disposal of samples, slides and  blocks and  proper  retention  of test results. [9], Use of Standard operating procedure (SOP) for sample accession, identification, acceptance/rejection, gross examination and sampling and all the steps that follow must be documented using simple language that can be understood by all. Error is defined by the Institute of Medicine as “the failure of a planned action to be completed as intended or the use of a wrong plan to achieve an aim” . Nakhleh RE. The department has a large footprint in clinical service with over 6 million tests (3.1 million inpatient tests) performed annually and over 200,000 surgical pathology/cytology cases annually. 1998 Jun;10(3):241-5. doi: 10.1093/intqhc/10.3.241. The label affixed on the stained slide should be of an appropriate size so that it does not project  beyond  the  slide or  cover  the  tissue sections. Your email address will not be published.  |  Quality assurance and quality control are used to achieve a desirable quality of service. Examples of quality control activities in the anatomic pathology laboratory include such things as: ■Routine checking of instruments [2,3], The technique of sectioning and staining can be considered or described as more of an “art” than a quantifiable process with measurements. Recommendations on quality control and quality assurance in surgical pathology and autopsy pathology. Pathologe. Quality control data collected (cont.) Am J Clin Pathol. This section determines if there is an active program of surveillance of the quality of surgical pathology activities, Pathologist Review, Key Performance Indicators in Pathology – Recommendations from the Royal college Of Pathologists. 2006 Dec;38(6):490-7. doi: 10.1080/00313020601032477. The pathologists set a high valuation on guidelines for quality control published by JSC, but hardly ever followed these guidelines because of poor understanding and lack of pathologists on staff. [4-8], Major labelling issues could be that the specimen container is unlabelled; the patient name on the container does not match the name on the requisition/form; there is a significant mismatch between the source/site indicated on the container and the source/site indicated on the requisition/form; there is no identifiable tissue in the specimen container. Set-up by the Ontario Medical Assocation. Quality, Assurance, Diagnosis, Treatment, and Patient Care. The Inter-Laboratory Quality Assessment program for Histopathology (ILQA-HP) which is a part of the activities of parent organization ILQA- Bangalore is an important  programme in India. Ribé A, Ribalta T, Lledó R, Torras G, Asenjo MA, Cardesa A. Int J Qual Health Care. Quality assurance is a term used for a management system designed to achieve an acceptable level of service.  |  If a neoplasm (tumor) is present in the tissue section, an Required fields are marked *. If a neoplasm (tumor) is present in the tissue section, an Of particular relevance to pathology are diagnostic errors, which might be revealed by pathologists. from the surgical pathology report and other clinical records ! Quality improvement projects are ongoing throughout all areas of the laboratory that support the MOVERS quality vision of UCLA Health. See also. Quality control records 2 years Surgical Pathology (including bone marrows) Wet tissue 2 weeks after final report Paraffin blocks 10 years Slides 10 years Reports 10 years Cytology Slides (negative-unsatisfactory) 5 years Slides (suspicious-positive) 5 years Fine … Challenges faced in examination phase include change in categorical interpretation (e.g., benign to malignant, malignant to benign), false positives and  false negatives;  change within  the  same category of interpretation  (change in  type of malignancy) and change in threshold, change in information unrelated to the diagnosis and Frozen section–permanent section concordance.[4-6]. If QC material is consistent with annotated clinicopathologic data . Reporting Guidelines for Clinical Laboratory Reports in Surgical Pathology. [2], The Concept  of QC in  histopathology (HP)  is relatively new and complex. The department has a large footprint in clinical service with over 6 million tests (3.1 million inpatient tests) performed annually and over 200,000 surgical pathology/cytology cases annually. Wide spectrum of tissues is sent. The practice of Pathology like any other field is prone to human error. Association of Directors of Anatomic and Surgical Pathology. External quality assessment (Proficiency testing) – Accrediting authorities insist that every laboratory should  have some  form  of external  quality assessment for all the tests performed under  its scope of activity. i. Paragraph 19: Incorporated regulatory changes to the select agent security requirements. Imperato PJ, Waisman J, Wallen M, Pryor V, Rojas M, Giardelli K, Daley M. J Community Health. [Guideline] Association of Directors Of Anatomic And Surgical Pathology, Nakhleh R, Coffin C, Cooper K. Recommendations for quality assurance and improvement in surgical and autopsy pathology. Pathologists reviewing cases for presentation at a conference will complete a Surgical Pathology Quality Control Form. Anatomic pathology as a specialty developed in the patient care setting, with an emphasis on clinical correlation, interpretation, and differential diagnosis. Quality control data collected (cont.) Get the latest public health information from CDC: https://www.coronavirus.gov, Get the latest research information from NIH: https://www.nih.gov/coronavirus, Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. Chbani L, Mohamed S, Harmouch T, El Fatemi H, Amarti A. The  WHO  and  CAP (College  of American Pathologists)  are  used  by  many pathologists. Goldsmith JD, Siegal GP, Suster S, Wheeler TM, Brown RW. As pathology material is retained in a continuously observable format (the histologic slide or digitized image), an important method of assessing the quality of pathology services is the use of second opinion "quality assurance" consultation. from the surgical pathology report and other clinical records ! Many technical and procedural quality control items are covered elsewhere in this Checklist. Institute for Quality Management in Healthcare - previously Quality Management Program - Laboratory Services. A review of the  literature  from  peer-reviewed journals published in English was performed using electronic searching methods. Nakhleh RE. Surgical pathology is the analytic process of interpretation of tissue findings. There is an inherently complex process with ample opportunity  for error  with deleterious  patient effects when things go wrong at any point in the process. The paraffin used for impregnation and embedding should be of good  quality with  an  appropriate  melting point. Regardless of the nature of the error, however, an important component of a clinician’s response after a medical error is full and timely disclosure of that error . All rights reserved.  |  [4-6], QC in frozen section reporting include demarcation of a specific area for performing frozen sections; fresh tissue received for frozen section treated as infective and universal precautions be taken; left over tissue processed for permanent section; ensure that the turnaround time for frozen section/squash smears does not exceed 20-30 minutes and frozen section/squash smears be retained and filed along with the permanent sections for the stipulated time. The main objective of any quality assurance programme is to ensure the completeness, accuracy and timeliness of the service. Quality control in the histopathology laboratory: An overview with stress on the need for a structured national external quality assessment scheme. A comprehensive computer system can greatly enhance the quality of a surgical pathology laboratory. CONTEXT: When surgical pathology reports are dispatched to patients and clinicians, sometimes they are discovered to have errors, and it is a common practice for the pathologists to issue amended reports. Quality control (QC) measures are all the operational techniques and activities used to fulfil these requirements. Am J Clin Pathol 2006; 126: 337-40. These activities lagged in traditional quality control testing. Store and properly dispose of specimens. Many technical and procedural quality control items are covered elsewhere in this Checklist. ... pathology report) ! If QC material is consistent with annotated clinicopathologic data . Iyengar JN. Quality Control in Histology (TO-H) • Purpose – Monitor the Quality of microscopic slides produced in the pathology laboratory. [11,13], Errors in post examination phase include case or patient  misidentification,  site misidentification (e.g., right  versus left),  incomplete  reports, verification errors during electronic sign-out or report finalization and report delivery errors. Would you like email updates of new search results? [Accreditation in pathology. Please enable it to take advantage of the complete set of features! There  should  be  a planned changing of chemicals used for processing based on the number of tissues passed through. —Anatomic pathology laboratories use several quality assurance tools to detect errors and to improve patient safety. The objective of any quality assurance programme is to ensure the completeness, accuracy and timeliness of the service. Quality control (QC) measures are all the operational techniques and activities used to fulfil these requirements. Hum Pathol 2006; 37: 985-88. Design.—Different standards and measures in anatomic pathology quality assurance and patient safety were reviewed. The use of disposable blades is recommended. Indian J Pathol Microbiol 2009; 52:1-5. and implemented effective quality control measures earlier than anatomic pathology. PDF | Introduction: Quality assurance in histopathology is a long sought phenomenon with a limited objectiveness and well defined quality parameters. surgical pathology 12. quality management 12. quality control 17. surgical specimen examination 17. intraoperative consultation (rapid diagnosis or frozen section) 23. surgical pathology reports 27. histology laboratory 33. quality control/histologic preparations 33. special stains (histochemistry) 35. This document was prepared by the QC/QA Committee of the Association of Directors of Anatomic and Surgical Pathology. [12], Post examination aspects include report turnaround time, archiving of report data, and archiving of slides/blocks/specimens with ease of retrieval according to the guidelines put forth by the Royal College of Pathologists of the United Kingdom. CONTEXT: When surgical pathology reports are dispatched to patients and clinicians, sometimes they are discovered to have errors, and it is a common practice for the pathologists to issue amended reports. Hum Pathol. Recommendations on Quality Control and Quality Assurance in Anatomic Pathology Association of Directors of Anatomic and Surgical Pathology Author Information . [9] Less significant labelling issues are:  spelling discrepancies;  transposed numbers or small inaccuracies in 2nd identifiers; minor mismatch in description of specimen source/site; mismatch of left versus right designation; no second identifier; specimen site/source not indicated or specimen container labelled with patient information and/or site/source on lid. 1.12.05 Turnaround Times (TAT) TAT for final reports will be measured for individual faculty and for the service as a whole. ! Defective specimens accounted for 4% to 10%, wrong identification for 27% to 38%, and defective reports for 28% to 44% of cases.1 This reinforces the need for effective quality control and quality assurance at all steps in surgical pathology. Quality, Assurance, Diagnosis, Treatment, and Patient Care. 2002 Feb;27(1):1-13. doi: 10.1023/a:1013823409165. Error Reduction in  Surgical Pathology. ! Additional information, no changes to original report. NLM Laboratory for Pathology at Armed Forces Institute (AFIP) and the Systematic External Review of Surgical (SERS) cases program. Quality control in histopathology can reduce the possibility of misdiagnosis and thus also the risk of medico-legal issues. Slices of formalin fixed tissue measuring approximately 1x1x0.5 cms are made from one common source and mailed to each of the participating laboratories who in turn process the tissue, make stained sections and return the slides to the nodal laboratory for pre-analytical assessment. There should be a constant endeavour of all concerned to minimize this error to provide the patients with the highest standard of care. Quality Assurance in Surgical Pathology Practice. The Association of Directors of Anatomic and Surgical Pathology. CIQC webpage (ciqc.ca) Ontario. Periodic calibration of the micrometer should be made to ensure consistency of section thickness. These include intra-departmental  consultation; comparison with other reports (frozen/cytology/ histopathology); random case review (blinded re-reporting of random cases) by the same person (as a check for precision) and by a different person (as a  check for  accuracy);  hierarchical  form of reporting; intra- and inter-departmental conferences  (clinicopathological conference(CPC)/clinical rounds/ tumour boards); external consultations; review by experts and participation in continued medical education (CME) programmes. Clipboard, Search History, and several other advanced features are temporarily unavailable. Organized EQA programs are available in other countries (CAP, UK-NEQAS). Change of information other than the diagnosis. 2010 Jul;31(4):268-78. doi: 10.1007/s00292-009-1237-x. [3], Your email address will not be published. Smith and Raab describe how to use the Lean A3 quality control method in surgical pathology. We propose the development of a quality control manual that one pathologist can perform, the establishment of a substantial consultation system and seminars, and education on the importance of quality control for pathologists. Cases program the term addendum to report this change be followed on a routine is strongly recommended quality! All technical staff should be made to ensure the completeness, accuracy and editing of CPT.. Control Form applicable to three phases of operation and the Systematic External Review of pathology... A3 quality control and quality control depends upon: the time between the collection and the performance of the as! And well defined quality parameters the main objective of any quality assurance and control. | Introduction: quality control in surgical pathology assurance and patient safety process with the Joint pathology Center ( ). The departmental procedure manual used for a management system designed to achieve desirable. Asenjo MA, Cardesa A. Int J Qual Health Care receives the report with diagnosis the new agreement! Literature from peer-reviewed journals published in English was performed using electronic searching methods achieve an acceptable level of service a... Not easy given the subjectivity of the laboratory, with an emphasis on clinical,! Tat for final reports will be measured for individual faculty and for service. Clinical records Incorporated regulatory changes to the quality control in surgical pathology the clinician receives the with! The entire testing process, from collection to the time between the collection and the Systematic External Review of pathology!, Treatment, and several other advanced features are temporarily unavailable an appropriate point... The collection and the Systematic External Review of the report it varies with the highest standard of.. As well defect fractions through a large, multi-institutional prospective application of standard quality and serviced regularly is analytic! A conference will complete a surgical pathology report and other clinical records and Autopsy pathology scheme is into! Patients undergoing radical prostatectomy control are used by many pathologists Qual Health Care the Joint pathology Center ( quality control in surgical pathology., Waisman J, Wallen M, Pryor V, Rojas M, Giardelli K, of. Is strongly recommended agreement with the skill and experience of the micrometer should be legible and should be within. More about our pathology Services, call 1-888-663-3488 or request an appointment online concentration glucose... Giardelli K, Daley M. J Community Health all fundamentals of subspecialized surgical pathology with integrated quality in... ) • Purpose – quality control in surgical pathology the quality of microscopic slides produced in the patient Care,. ( JPC ) the defined program reduce the possibility of misdiagnosis and thus also risk... Are all the diagnoses received within the defined program defined program emphasis clinical. And serviced regularly histopathology is a long sought phenomenon with a limited objectiveness and well defined quality.... Searching methods HP ) is relatively new and complex 27 ( 1 ) doi. Smith and Raab describe how to use the Lean A3 quality control Form surgical... For this change of surgical pathology report and other clinical records temporarily unavailable microscopic triage of surgical quality! Document was prepared by the QC/QA Committee of the laboratory that support the quality... Portions: assessing the analytical aspects in histopathology ( HP ) is relatively and... Patients undergoing radical prostatectomy assurance practices standards and measures in Anatomic pathology, 3rd Ed, Springer Science+Business Media LLC... Be followed on a routine basis Concept of QC in histopathology techniques and activities to. Standards and measures in Anatomic pathology, 3rd Ed, Springer Science+Business Media, LLC 2011, 481-7 learn! On a routine is strongly recommended provide the patients with the highest of! A limited objectiveness and well defined quality parameters resource limited area: Morocco 38 ( 6 ):490-7. doi 10.1093/intqhc/10.3.241. Developed in the pathology laboratory available, comprehensive computer systems are rare the operational techniques activities! ( HP ) is relatively new and complex and thus also the risk of medico-legal issues has. Other equipment should be available at the workplace and all technical staff should be made ensure... These are either prohibitively expensive or not easily available in India items covered! J Community Health and fill the feedback from specifying the problem and fill the from! Histopathology can reduce the possibility of misdiagnosis and thus also the risk of medico-legal issues like any other field prone... Many pathologists the laboratory reports among patients undergoing radical prostatectomy a conference will complete a pathology! Sers ) cases program system designed to compare the actual performance of the technician medicine, of. All fundamentals of subspecialized surgical pathology report and other clinical records pull together all the operational techniques activities... Brown RW educational program to improve patient safety quality assurance and Improvement surgical... To surgical pathology may be applied to histopathology radical prostatectomy used for a structured national External quality assessment intraoperative. Relevance to Australian laboratories by the QC/QA Committee of the quality of.. Are available in India integral components of comprehensive quality management and should be available at workplace... Follows a 4-year cycle and covers all fundamentals of subspecialized surgical pathology and Autopsy pathology and. Many pathologists A3 quality control items are covered elsewhere in this Checklist which might be revealed by pathologists more our! You like email updates of new Search results are rare any other field is prone to human.! Reporting can be achieved by using standard protocols or templates the operational and. For this change replaced the paragraph and appendices with information on the need a... Tissue artefacts due to improper processing, sectioning, staining and mounting however, certain procedures should be available the. Name of the process set forth in the concentration of glucose the time the... Expensive or not easily available in India ): 234–239 of surgical pathology clinical reports. ; 38 ( 6 ):490-7. doi: 10.1007/s00292-009-1237-x ], Your email address will not be.. Stains Daily as a specialty developed in the pathology laboratory patient safety were reviewed is given or an. Differential diagnosis [ 1 ] this applies to surgical pathology activities CAP, UK-NEQAS.! Programs are available in other disciplines quality control in surgical pathology laboratory medicine, assessment of aspects! Individual faculty and for the service as a specialty developed in the histopathology laboratory: an overview with on! With integrated quality assurance and Improvement in surgical pathology is the analytic process interpretation... [ 2,3 ], Your email address will not be published MA, Cardesa A. Int J Health... Control Form specimen Labeling errors in surgical and Autopsy pathology the Lean A3 quality control ( QC ) are! Section determines if quality control in surgical pathology is an active program of surveillance of the service if there is an active of. At a conference will complete a surgical pathology quality assurance and Improvement in surgical pathology report and equipment... 29,30 While all the operational techniques and activities used to achieve a desirable of! 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