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How well do we do in Pathology?

How well do we do in Pathology?. “…. Incorrect patient identification was involved in 13% of surgical errors and 67% of transfusion errors.”. How well do we do in Pathology?. Studying the workflow. Understanding Workflow.

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How well do we do in Pathology?

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  1. How well do we do in Pathology?

  2. “…. Incorrect patient identification was involved in 13% of surgical errors and 67% of transfusion errors.” How well do we do in Pathology?

  3. Studying the workflow

  4. Understanding Workflow Histology laboratories have a very standardized workflow which mainly varies in the degree of automation, layout and work schedules rather then process steps Accessioning Administration Quality Assurance Case Record Creation Complex / Small Tissue Sample Examination Grossing Tissue Processing and Embedding Tissue Cutting Cutting and Sorting Slide Sorting Special Staining IHC Staining ISH Staining H&E Staining Staining Sorting Slide Sorting (to Patient Cases) Screening & Interpretation Pathologist Slide Reviewing No Further Testing Required Reruns or Additional Testing Required Archiving Blocks and Slides to Storage

  5. Surgery and Sampling DIAGNOSIS Pathologist’sInterpretation Accessioningand Grossing Manual Processes IHCStaining Embedding Sectioning PatientID on Slide Tissue Sampleon Slide Deparaffinization Microscopy H&E Staining Target Retrieval Manual Processes Dominate the Pathology Lab

  6. Three Pillars RightPatient RightTreatment Right Diagnosis

  7. Integration of processes through the entire pathology laboratory eliminates steps that might introduce errors. Specimen in the right block? Number on Block? Correct Registration? Will the right specimen follow the right patient record? Is Data Registration done correctly? Right Sample? Correct Registration? Right specimen to slide? Right label? Right Data Reg.? Operating Room Right Patient? Correct Registration? Right Fixation Right Label? Right Staining? Right Reagent? Right Protocol? Concentration? Right Buffer? Correct Reg.? Right Label? Right Storage and Retrieval? Correct Diagnosis? Virtual Feedback? Right Patient?

  8. Processing Grossing Embedding Sectioning LAN and LIS Dako Link Middleware Hospital Patient Pathologist The Pathology Lab Present Focus Areas Processing Grossing Embedding Doctor Surgery Sectioning SpecimenReceivingand Data Entry Staining Slide Viewing

  9. Sources of errors in process Biopsing Fixation Preparation Preparation phase Sectioning Drying Where OurPartnership Helps The Most! 19683 variations Deparaffination Pre-treatment Antibody IHC Staining Detection Counterstain Control Cut-off value Tumor entity Reporting Interpretation phase 314 = 4.8 mio procedures (3 choices in 14 steps)

  10. PATHOLOGISTS

  11. The Human Eye - Strength • The human eye is unsurpassed at pattern recognition

  12. Image Analysis System

  13. Barcoding verses Keyboard Entry • Ohio University study found: • That a well-trained data entry operator makes a data entry error 1 in every 300 keystrokes. • Scanning a code 128 linear barcode produces 1 error in 2.8 million (worst case) and 1 error in 37 million (best case). • Scanning a Datamatrix 2D code produces 1 error in 10.5 million (worst case) and 1 error in 612.9 million (best case). Linear Barcode Datamatrix 2D code 1 Ohio University Center for Automatic Identification. “Code 16 and Code 49 Data Integrity Test Executive Summary” “DataMatrix and PDF417 Data Integrity Test Executive Summary” Online http://www.barcodefaq.com/efficient-barcode.html

  14. Staffing issues Reference :- http://loosepixels.com/barcodes1.htm

  15. Transcription problems

  16. Transcription problems SOS 50S 505 5O5 S05 1405 1705 1905 14OS 17OS 84 B4 89 B7 B9 BY

  17. Transcription problems

  18. Transcription problems

  19. Manual test requests Specimen labeling Tracking of block locations Hand written comments in wax Slide storage track Manual slide workflow logs Post-it note tracking Manual archive track Diagnosing the Problem Center Oncology

  20. Pathologist Sued, Wrong Diagnosis Given, woman looses breast. Mix up in specimens Daily Morning Star Oct, 28 2007 Volume 1, Issue 1 How does it Matter? Lawsuit $1,750,000

  21. A Competitor Story-BG Pathology

  22. Link Hospital Software Middleware LAN and LIS Pathology Lab Reagents Instruments EnVision™ FLEX and FLEX+ Autostainer Plus Link PT Link The Link Solution

  23. Dako Link Server Dako Link Managers Local Area Network (LAN) Hospital LIS Server Pathologist Patient LIS Connectivity • Single point accessioning • True Positive ID • Less time spent entering data • Fewer errors

  24. LAN Connectivity Order protocols for new cases Program and label slides Remotely diagnose and update instruments Quickly access the status of any case LIS Server Monitor case completion and instrument status

  25. Introducing Autostainer Plus Link • Builds on the Dako Autostainer platform to continue providing confidence in your results • Unites our trusted IHC stainer with innovative Dako Link software and connectivity options for added security

  26. …from another office …from another building …from another country Instrument Connectivity Control multiple stainers… …from one workstation.

  27. Staffing issuesTHANK YOUDR. ST.ALEXOVdr_alexov_pathology@yahoo.com Reference :- http://loosepixels.com/barcodes1.htm

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