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