Workflow of clinical pathology department
1.Receipt of pathological examination application form and specimens sent for examination
The application form for pathological examination is a consultation form sent by the clinical department to the pathology department, which is the clinical textual information necessary for pathologists to make pathological diagnosis and is a document file with legal significance. Therefore, clinicians should carefully fill in the relevant items in the application form item by item, and send the specimen to the pathology department with the examination after being signed by the hospital physician who manages the patient. When receiving the application form and the specimen, the pathology department should check the two carefully for the first time. The pathology department shall respond promptly, including contacting the sending department or returning, any of the following cases.
(1) the application form does not match the specimen sent for examination, including the container holding the specimen is not labeled reporter;
(2) important items in the application form is not filled in the vacancy, or medical history and clinical examination (including intraoperative examination) is too simple;
(3) specimens sent for examination due to serious autolysis, dry shrinkage, corruption, or the wrong use of non-fixed solution (such as disinfectant, etc.) soaked;
(4) the main foci of specimens sent for examination were dug up in advance or a specimen sent to two units.
For specimens that meet the requirements for sending specimens for examination, the person receiving the specimen will sign the specimen sending book in the relevant department, or issue a notice of receipt of the specimen.
2. Numbering and registration of application forms and specimens sent for examination
On the day of specimen collection, the staff of the pathology department will number the application form and the specimen in time, and register them after the second check. The registry and (or) microcomputer records, application forms, the number on the container of specimens sent for examination should be identical.
3, large specimens of additional fixed
For large specimens sent for examination, the pathologist should make appropriate sections without affecting the positioning of the main lesion and add 10% neutral formalin to supplement the fixation. The interval between fixation and sampling should be more than 12h.
4.Major examination, sampling and recording
This operation, in principle, should be attended by two people, of which one is the recorder. The recorder should record in detail the verbal description of the person taking the material, and at the same time undertake the task of reading out the code of the application form, the name of the patient, the main medical history, what is seen intraoperatively, the number of specimens sent for examination, and inform the person taking the material of the special requirements of the clinical examination, and place a small number for supervision of the person taking the material.
The collector should be in the recorder read the above, the specimen container number, name and the number of specimens for the third time to check. If you find that the number of specimens does not match, the specimen should be placed separately, to be processed after contact with the clinic.
Giant examination of the observation, description and sampling should be carried out in accordance with the requirements of Chapter 3.
After repeated inspection, still not found in the specimen sent for examination of the lesions mentioned in the clinic, the specimen should be set aside, to be processed after contact with the clinic; if necessary, invite the surgeon to participate in the taking of materials.
In one of the following cases, a small serial number should be written after the specimen number and the number should be placed and fixed together with the corresponding tissue block.
(1) A patient is sent more than one specimen for examination;
(2) specimens with special markings indicated in the request form;
(3) A large specimen taken from multiple locations;
(4) Basal and cut margins of radical specimens, lymph nodes detected or sent for examination;
(5) Supplementary sampling.
When placing small numbers, they should be placed strictly in numbered order and should not be misplaced. Small numbers should be placed on the embedding side of the tissue block.
After each specimen is retrieved, the retrieval table and retrieval apparatus should be rinsed to prevent contamination of tissue debris between specimens.
Specimens that have been taken should be placed separately in order and with sufficient fixative. After all the specimens are taken on the same day, they should be moved to the specimen storage rack and stored according to the date they were taken. After 2 weeks from the date of the report, the specimens will be cleaned up uniformly.
After all the specimens are taken on the same day, the collector and the recorder will count the total number of specimens taken on the same day and record it on the reverse side of the last application form or on the daily specimen record sheet for verification by the technical staff.
The person who takes the material and the recorder sign under the relevant records respectively.
5.Dehydration, transparency, wax dipping
Specific operations should be carried out in accordance with the requirements of the Specification (II).
The technician should check the total number of pieces taken before dehydration. If the operation is automated, the total number of blocks taken should be checked before embedding, and if discrepancies are found, contact with the person who took the material should be made and joint inventory.
6.Embedding, slicing, staining and sealing
When embedding, should be strictly divided into pieces, and at the same time package the corresponding small number, do not package the wrong. Do not wrap pieces of fabric (scraps) of unknown origin arbitrarily to prevent contamination in the process of embedding.
Cutting, laminating (paste) film should be strictly divided into wax blocks to complete, do not laminating (paste) film water residue on all pieces of debris, in order to eliminate laminating (paste) film contamination in the process.
When mounting (paste) the film, must pay attention to the wax block number and the slide on the number of the exact same, to eliminate the error caused by the wrong number.
After sealing, the label with the number should be added. The number of the label must be exactly the same as the number of the slide.
After all the work is finished, the technician signs in the producer’s column and files the wax blocks in order. If there is a person to keep the column, the custodian will check the total number of wax blocks and the total number of materials taken, and the two are in line with each other, and the custodian will sign and file.
7.Microscopic examination
After receiving the section of the day, the diagnostic staff will sign on the record book of section delivery in the technical room. If the number of slices is found to be inconsistent with the number of materials taken, they should promptly contact the technical room personnel for verification.
During the observation of slices, respond to the following conditions if they are found.
(1) There is obvious contaminated tissue within the slice, should contact and check with the technical room personnel;
(2) The content of the section does not match with the tissue sent for examination, contact should be made with the technical room personnel and the person who took the section, respectively, and if necessary, with the sending department;
(3) Poor sectioning or staining quality should be contacted with the technical staff and, if necessary, re-produced;
(4) For those who need to make deep cuts, continuous cutting, special staining and immunohistochemistry in order to fully observe the lesion, they should write out their opinions in the remarks column of the application form and sign. Then hand over to the technician in charge of sectioning, who should complete the required filming work in time.
8.Issue pathological diagnosis
Pathological diagnosis is the conclusion made by the pathologist after examining the specimen sent for examination, combining with clinical data, analysis, synthesis and judgment, and must be written very carefully. The handwriting should be clear, and the key words (such as cancer, tumor, negative, positive, etc.) should be so, not scribbled or made up simplified words, and these words should not be altered. If the report is printed by microcomputer, the format should be uniform and free of typos. Before the report is issued, the initial and reexaminations should be signed by the hand.
Pathological diagnosis should be written in the form of rewriting, the first link as a diagnostic report issued; the second link that the rewritten link in the corresponding pathological diagnosis column on the back of the application form, as a stub for inspection, the rewritten handwriting should also be clear.
Pathologists are not allowed to issue false reports or signed blank report forms at the request of the personnel concerned. If the original report is lost, the director of the pathology department will agree to issue a replacement in the form of a “copy”.
Period of issuance of pathological diagnosis: Under normal circumstances, it should be issued within 3 days from the date of specimen receipt (except for holidays).
If the pathological diagnosis cannot be issued as scheduled due to additional material, deep cuts, special staining, decalcification, extended fixation (such as tuberculosis specimens), consultation or immunohistochemistry, the clinical department should be notified verbally or a “notice of late issuance of pathological diagnosis” should be issued. The reason for late issuance should be stated on the notification form.
The pathological diagnosis is a medical document signed by the pathologist and must be treated with care.
9.Sending and receiving of pathological diagnosis
The pathological diagnosis of inpatients shall be delivered by the pathology department to the nurse office of the corresponding department, and the recipient shall sign in the signature column; the pathological diagnosis of outpatients shall be delivered by the pathology department to the office of the outpatient department or the corresponding department, and the recipient shall sign in the signature column. Reports marked with “self-collection” should be signed by the sender to the pathology department. Interns and trainees are not allowed to participate in signing.
10.Registration and filing of pathological diagnosis
After the issuance of the pathological diagnosis, the diagnosis should be registered in the register in time. The pathology application form and relevant textual information (such as consultation opinions, etc.) should be filed in a timely manner. If there is a full-time file manager, it should be submitted to the manager for signature and filing. File management should strive to be standardized and complete. Textual and written files should be stage-bound and easily accessible. Those who use microcomputer archiving should be operated by a dedicated person.
At the same time, pathology slides and wax blocks should also be archived.
The archiving time of pathology slides and wax blocks should be more than 15 years, and the maximum retention time should be reported to the hospital and (or) health authorities for approval depending on the specific situation of the unit.
11.Slice loan
Whether or not the slides are lent and the method of lending shall be stipulated by the hospital and may be handled in the following two ways.
(1) If the patient needs to borrow the slides due to referral or overseas consultation, he/she should fill in the borrowing form and go through the borrowing procedure according to the hospital regulations, and then the pathology department will copy the required slides and check them with the original reporter and the department head before lending them out. Under normal circumstances, the original slides will not be loaned out. Wax blocks are important files that cannot be reproduced and in principle cannot be loaned. If the consultation unit really needs to do special staining or immunohistochemistry, the re-cut wax slides (white slides) can be borrowed, or the pathology department of the consultation unit can directly negotiate with the pathology department of the original diagnosis unit, and the borrower will be responsible for returning them.
(2) If the hospital stipulates as not agreeing to lend the section, the pathology department shall meet the patient’s needs in the form of color graphic report or consultation.
12.Consultation
Pathologists should strive for consultation within the department or among peers in case of difficult cases. The consultation can take the form of computerized remote consultation, postal section consultation and reading consultation, etc. The section and/or wax block shall be provided by the pathology department requesting the consultation. The consultation opinion should be recorded or attached to the request form for pathology examination of the case and filed together. If the consultation opinion is inconsistent with the original diagnosis, the physician of the original diagnostic pathology department shall decide whether to change or issue a replacement pathology diagnosis report. For consultation at the request of the patient or with the consent of the patient, the full cost of the consultation shall be borne by the patient.
For difficult cases, or when the pathological diagnosis differs from the clinical diagnosis, interdisciplinary communication and consultation with clinical departments should be sought.