QA Flashcards

Question

List components of a complete surgical pathology report

Answer 1

Patient ID: name, DOB, health card number, hospital number Physician ID Dates when specimen was collected, recieved, processed, reported Diagnosis Gross description: labeling, container in which recieved, medium in which recieved, whether opened, orientation, dimensions, weight, sampling, block description Microscopic description If relevant: special stains, IHC, biomarkers, molecular, IF, EM, Adequacy, references, additiona comments, additional comments, intaoperative consultation diagnosis, cancer synoptic report, communication with physician, details if corrected/amended, addendum Diagnosti SNOMED coding Optional quality-type coding

Answer 2

Intraop consultation: 90% of cases reported within 20 min per block Surgpath specimen: 80% of routine cases reported within 2 working days Autopsy: prelim 3 working days, final 30d for routine, 3 months for complex

Answer 3

Most wet tissues 4 weeks after final report Most slides/blocks 20y

Answer 4

Turnaround time Intraoperative consultation-permanent section discordant rate

Answer 5

Technical issue: 10% Interpretative error: 40% Sampling error: 40% Incorrect or incomplete clinical history: 10%

Answer 6

Agreement Deferral, appropriate Deferral, inappropriate (10% threshold) Disagreement, minor Disagreement, major (3% threshold)

Answer 7

No clinical significance Minor or questionable significance Major or potentially major significance

Answer 8

* Preautopsy process timely and complete * Permissions appropriate and paperwork complete * CLinical questions and medicolegal issues addressed * Clionicopathological correlation provided in report * Safety regulations adhered to during autopsy * Consultation sought for subspec expertise * Findings documented via photographs * Tissue blocking and slide prep timely and of good quality * Ancillary studies used appropriately * Prelim and final reports acceptable TAT * Cases reviewed at M&M rounds * Peer review process followed

Answer 9

* Consent * Clinical information and questions to be answered by the autopsy * Gross findings * Microscopic findings * Primary diagnosis and comments * Cause of death

Answer 10

Lab personnel Physical facilities and equipment Requisition forms, specimen collection, and acessioning Preparation and staining techniques Cytotechnologist responsibilities Screening practices Diagnostic practice Reporting Records Gynecologic cytology utilization registry QA practices Performance evaluation Continuing education practices

Answer 11

Gyne: papanicolaou Fixed nongyne: papanicolaou Air dried nongyne: Romanowsky-type staining, Giemsa-Wright Cell-block prep: H&E

Answer 12

Should be monitored daily with appropriate correction of suboptimal results Should be filtered or replaced regularly to maintain potency and freedom from contamination

Answer 13

Must be a legally qualified physician with qualifications in AP and cytopathology. Recommended that the director have extra training and/or experience in cytopathology and lab management to oversee the quality of the lab

Answer 14

Update lab manuals (at least annually) Generate lab QA reports (at least annually) Conduct regular meetings (at least quarterly) with all lab personnel to discuss lab performance and measures for quality improvement as necessary Facilitate lab-based CME for all lab personnel Identify deficiencies in knowledge, attitude, and skill of lab personnel Faciliate remedial training for lab personnel asd needed

Answer 15

All nongyne and gyne specimens must be screened by cytotechnologist Hierarchical screening by senior cytotechnologist or second mandatory screening by another cytotechnologist may be carried out in some labs Automated screening by approved commercial devices may be used in some labs following protocols recommended by the manufactuer and regulatory bodies

Answer 16

They should * have malpratice insurance * consult as needed with cytotechnologists, lab and clinical colleagues * keep up to date by reviewing current literature and participating in CME * maintain diagnostic competence in areas they report specimens * Obtain pertinent clinical information * Report all cytolog cases referred to them by cytotechnologists * Provide appropriate feedback on case material to cytotechnologists

Answer 17

Methods include: prospective screening (random, targetted, rapid, or prescreening), retrospective screening Cytotechnologist with established competence carried out all manual rescreening Aim of rescreening procedures is to identify false negative results

Answer 18

Total of 10% of all negative gyne cytology specimen should be prospectively rescreened. These slides will be selected through a combination of random and targetted rescreening

Answer 19

Involves rescreening a slide if a patient belongs to a high risk group * CLinical history of vaginal bleeding or spotting * History of cervical/vaginal/vulvar carcinoma * previous cytology reported as at least atypical squam/glandular cells within 2 y * Abnormal cervix on speculum exam

Answer 20

This involves rescreening 10% of randonly selected negative gyne cyto slide Questionable value in detecting false negatives

Answer 21

Involves rescreening all neg gyne cyto slides for a specific time period (<1min) after a routine screen. Precudes the 10% random rescreen Increased detection of false negs with this technique

Answer 22

Involves reviewing all gyne cyto slides for abnormal cells (<2min) prior to the full routine screen (at least 6 min). Precludes 10% prescreen Increased detection of false negs

Answer 23

If current sample shows high grade abnormality, screening technologist pulls and rescreens the patient's neg gyne cyto slides from the previous 5y. All slides referred to pathologist for review Corrected report issued only when findings on rescreening change the patient's current management Findings used for educational feedback

Answer 24

Nongyne cyto: malignant cases should be correlated when tissue available. Correlation with concurrent surgical pathology also recommended Gyne cyto: comparison with concurrent colpo sampled should be carried out. Diagnoses of high grade lesions should be compared to follow up biopsies

Answer 25

Involves correlating cytological dx with biopsy, resection, autopsy dx * Help resolve apparent cyto-histo discrepany * Streamline and standardize lab diagnostic criteria * Provide valuable CME material for lab staff and trainees

Answer 26

1. Primary HPV screening 2. Up-front cotesting approach in which both HPV test and cervical cyto specimen are obtained at time of screening 3. Triage of abnormal cyto result using HPV testing 4. HPV genotyping - allowed for selective reporting for those with increased risk

Answer 27

10-20% have underlying HSIL

Answer 28

ASC:SIL shoud not exceed 3:1 ASC-H should represent <10% of all ASCs AGC should represent <1% of cases

Answer 29

Should be documented annually and include: * Productivity rates for cytotechs and cytopaths * Individual performance indicators * overall lab performance * Specimen adequacy

Answer 30

* Total number and rates of unsat specimens of the lab, each cytotech, cytopath * Total number and rates od each major diagnostic ategory for lab, cytotech, cytopath * False neg/pos rates on 10% rescreening * High risk HPV rate in AS cases * ASC:SIL ratio for lab and cytopath * Cytohistological correlation rates for each diagnostic category * False neg/pos rates on cyto-histo correlation * Screening misses of ASC-H or AGC or other abnormality that changes management * Lab TAT

Answer 31

* Total number of cases categorized by anatomic site and specimen type * Total number and rates of unsat cases for lab, cytotech, cytopath * Rates for major diagnostic categories * Correlation of FNAB with surgical material * Major and minor discrepancy rates between cytotech and cytopath * Lab TAT

Answer 32

1. Number of corrected and supplemental cyto reports issues by lab and/or individual pathologists 2. Number of internal and external cyto consultations 3. Number of external review requests, reasons for external consultation, diagnostic discrepancies

Answer 33

A comparison of the initial specimen adequacy assessment/prelim dx vs final

Answer 34

FNAB unsat rates FNAB complication rates/outcomes FNAB service satisfaction

Answer 35

1. Keeping up to date through review of current cytology journals 2. Consulting appropriate, current cytology textbooks 3. Attending scientific meetings, review courses, or specialty conferences 4. Attending lectures or symposia

Answer 36

If exclusively screening without othr duties, maximum 60-80 slies in 8h work day Labs with automated screening technologies such as field of view, number of slides should be adjusted as they are considered half a slide. Slides that require both field of view and full manual review are 1.5x

Answer 37

Gyne: * all cases of NILM with reparative changes * All cases of ASC/AGC All nongyne cyto

Answer 38

* CAP * ASCP * Lab services of ontario

Answer 39

1. A sample obtained from an unusual anatomic location 2. Cyto diagnoses that may results in high stakes treatment deisions 3. Major discordance between cytotech and cytopath interpretation

Answer 40

1. Establish QA committee (medical leader, technical manage, QA coordinator) 2. Develop QA plan based on CAP standard and AP workflow 3. Create quality manual 4. Covene regular committee metings to review, monitor, evaluate lab service to ensure quality standards are being met 5. Identify qualiy improvement opportunities and manage unxpected events

Answer 41

1. Identify a procss that needs to be improved by establishing realistic goals or responding to deficiencies 2. Measure current level of performance for that process 3. Determine target or desirable level of performance 4. Design and implement an intervention to achieve the desired level of performance 5. Monitor performance 6. Assess and document improvement

Answer 42

1. Policy - statement of intent, what is to be done, why 2. Process - interrelated steps involved in an activity 3. Standard operating procedure - specific details of how an individual performs the activity 4. Forms - documentation of what was done

Answer 43

* Apply to handling of human tissue * All specimens should be placed in a well constructed container with secure closure to prevent leakage during transport * Workers should use appropriate barriers to prevent skin and mucous membrane exposure when in contact with specimens * Workers should use biological safety cabinets for procedures that have a high potential to generate droplets * Workers should not use mouth pipetting * Workers should wash their hands and othr skin surfaes immediately and thoroughly if contaminated AND after completing a lab task * Workers should decontaminate equipment after use * Workers should take precautions with sharps

Answer 44

Patient name DOB Provincial health card number Hospital identification number Address Name of requesting health care provider Anatomic site and laterality Appropriate clinical history Date and time of specimen collection

Answer 45

Patient name DOB Identifying number Anatomic site and laterality

Answer 46

* Specimens should only be accessioned if ordered by an appropriate health care provider * A clear rejection policy should be developed and communicated to all lab users * Specimens should be accessioned with a unique number * Time and date of specimen receipt should be recorded * Accessing number should be recorded on each specimen and slide

Answer 47

2 unique identifiers - accession number and name

Answer 48

Accessioning Reporting Archiving records Accessing data for QA

Answer 49

* Incident review and root cause analysis * Performance review and performace management * Disclosure * Identifying and managing medicolegal concerns * Managing media relations

Answer 50

* Method of problem solving that identified root causes * The root cause is the factor that removal of which prevents a recurrence

Answer 51

To idehntify the causes, factors or sources of variation that led to a specific event, result, or defect in a product or process

Answer 52

Variety of techniques - cause mapping, change analysis, Ishikawa fishbone diagram, 5 whys Process poses 3 questions: 1. what was the problem 2. What were the causes of the problem 3. What actions should be taken to prevent the problem from recurring

Answer 53

1. Discuss case with colleague 2. If they agree - they should inform clinician and issue amended report 3. If disagree - third opinion should be sought 4. Notify clinician so not irreversible clinican management takes plae before diagreement is resolved 5. If colleague refuses to seek third opinion, notify lab medical director

Answer 54

Obtain clinical information as to the nature of the disagreement and surgeon's reasons for not approaching your colleague directly Review case Discuss situation with colleague If there is new information, collaborate with colleague to issue an addendum or corrected/amended report

Answer 55

Clarify reason for request Contact lab medical director to manage the issue

Answer 56

* Appropriate governance, and oversight at jurisdictional and instutitional level, linkaget to existing QA programs * Accreditation * A human resource plan, workload measurement and sufficent staffing * Appropriate training, licensure, credentialing and continuing professional development * Privacy, confidentiality, disclosure and duty to report * Informatics and qualityt documentation systems * Appropriate pathologist workspace and related tools