how well do we do in pathology?. “…. incorrect patient identification was involved in 13% of...

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

Case Record Creation

Complex / Small Tissue Sample Examination

Tissue Processing and Embedding

Tissue Cutting

Slide Sorting

Pathologist Slide Reviewing

No Further TestingRequired

Cutting and Sorting

Grossing

H&E Staining

Reruns or Additional Testing Required

Accessioning

Special Staining

IHC Staining

Staining

Screening & Interpretation

Slide Sorting (to Patient Cases)Sorting

Archiving

ISH Staining

Ad

min

istr

ati

on

Blocks and Slides to Storage

Qu

ali

ty A

ss

ura

nc

e

Histology laboratories have a very standardized workflow which mainly varies in the degree of automation, layout and work schedules rather then process steps

Manual Processes

DIAGNOSIS

Manual Processes Dominate the Pathology Lab

Surgery and Sampling

Accessioningand Grossing

Embedding

Sectioning PatientID on Slide

Tissue Sampleon Slide

Deparaffinization Microscopy H&E Staining Target Retrieval

Pathologist’sInterpretation

IHCStaining

Three PillarsRightRight

PatientPatient

RightRightTreatmentTreatment

RightRightDiagnosisDiagnosis

Integration of processes through the entire

pathology laboratory eliminates steps that might

introduce errors.Operating Room

Right Patient?Correct

Registration?Right FixationRight Label?

Right Sample?

Correct Registration?

Will the right specimen follow the right patient

record?

Is Data Registration done

correctly?

Specimen in the right block?

Number on Block?

Correct Registration?

Right specimen to slide?

Right label?

Right Data Reg.?

Right Staining?Right Reagent?Right Protocol?Concentration?Right Buffer?Correct Reg.?Right Label?

Correct Diagnosis?

Virtual Feedback?

Right Patient?

Right Storage and Retrieval?

SpecimenReceiving

and Data Entry

Slide Viewing

Staining

Grossing Embedding

Sectioning

Processing

Surgery

Doctor

The Pathology Lab Present Focus Areas

Pathologist Patient

Dako Link Middleware

Hospital

LAN and LIS

Embedding

Sectioning

GrossingProcessing

Sources of errors in process

314 = 4.8 mio procedures (3 choices in 14 steps)

Preparation Preparation phasephase

Preparation Preparation phasephase

IHC StainingIHC StainingIHC StainingIHC Staining

Interpretation Interpretation phasephase

Interpretation Interpretation phasephase

BiopsingFixation

PreparationSectioning

Drying

DeparaffinationPre-treatment

AntibodyDetection

Counterstain

ControlCut-off value

Tumor entityReporting

Where OurPartnership Helps The Most!

19683 variations

INTEROBSERVER VARIABILITY OF IHC HER2 EVALUATION 100 CASES

51 53 57 5964 66 68 72 74 74 75 77 78

93

68,6

0102030405060708090

100

% z

godn

ości

z w

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em

PATHOLOGISTS

The Human Eye - Strength

• The human eye is unsurpassed at pattern recognition

Image Analysis System

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).

Barcoding verses Keyboard Entry

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

Linear Barcode Datamatrix 2D code

Staffing issues

Reference :- http://loosepixels.com/barcodes1.htm

Transcription problems

Transcription problems

SOS

50S

505

5O5

S05

1405

1705

1905

14OS

17OS

84

B4

89

B7

B9

BY

Transcription problems

Transcription problems

Diagnosing the ProblemSpecimen labeling

Slide storage track

Hand written comments in wax

Tracking of block locations

Post-it note tracking

Manual slide workflow logs

Manual test requests

Manual archive track

CenterOncology

Oct, 28 2007Volume 1, Issue 1

Daily Morning

Star Pathologist Sued,

Wrong Diagnosis Given, woman looses breast. Mix up

in specimens

How does it Matter?

Lawsuit

$1,750,000

A Competitor Story-BG Pathology

Software Middleware

Link

Reagents Instruments

Pathology Lab

Autostainer Plus LinkEnVision™ FLEX and FLEX+ PT Link

LAN and LIS

Hospital

The Link Solution

Dako Link ServerDako Link Managers

Loca

l Are

a N

etw

ork

(LA

N)

Hospital LIS Server

PatientPathologist

LIS Connectivity

• Single point accessioning• True Positive ID• Less time spent entering data• Fewer errors

Remotely diagnose and update instruments

LIS Server

Order protocols for new cases Program and

label slides

Quickly access the status of any case

Monitor case completion and instrument status

LAN Connectivity

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

…from one workstation.

Control multiple stainers…

Instrument Connectivity

…from another office

…from another building

…from another country

Staffing issuesTHANK YOU

DR. ST.ALEXOVdr_alexov_pathology@yahoo.com

Reference :- http://loosepixels.com/barcodes1.htm