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United States Government Work, uncopyrighted, public-domain,
DRAFT COPY ONLY. This document does not necessarily represent the views
or policies of any United States Government agency.
This document is provided "as is", without warranty of any kind,
express or implied, including but not limited to the warranties
of merchantability, fitness for a particular purpose and
non-infringement. In no event shall the authors be liable
for any claim, damages or other liability, whether in an
action of contract, tort or otherwise, arising from, out of,
or in connection with the document or the use or other dealings
made with the document.
TO SUBMIT SPECIMEN TO ANATOMIC PATHOLOGY
TO LOOK UP A PATHOLOGY REPORT
See also: Receipt of specimens:
2, 3.
Specimen accessioning: 4,
5, 6.
7.
Material Safety Data Sheets: 253.
PRINCIPLE OF THE TEST.
The Anatomic Pathology Laboratory is responsible for processing all tissues
obtained at surgery, outpatient clinics, and postmortems in this hospital.
SPECIMEN REQUIRED.
All human tissue excised at surgery, outpatient clinics, and postmortems,
fresh or in fixative, along with a filled-out Tissue Examination Form
(U. S. Standard Form 515, USSF515),
a Gynecologic Cytology Form
(U. S. Standard Form 541, USSF541),
or a filled-out Authorization for Autopsy
(U. S. Standard Form 523, USSF523).
REAGENTS, INSTRUMENTATION.
Plastic containers. Tissue Processor. Neutral 10% buffered formalin.
70% Flex Solution. 80% Flex Solution. 95% Flex Solution. 100% Flex Solution.
Clearing Solution. Paraffin. Decalcifying solution (RDO).
Hematoxylin and eosin stain. Microtome. Water bath.
Alcoholic iodine solution. 5% sodium thiosulfate. 13% Thioacetamide.
Fluted filter paper.
STEP-BY-STEP DESCRIPTION.
1. TO SUBMIT A SPECIMEN TO THE ANATOMIC PATHOLOGY LABORATORY,
either hand-deliver the specimen fresh, or place the specimen in the
appropriate fixative (formalin for most solid tissue specimens;
Cytolyt for cytologies). For fresh specimens, be certain that a
pathology technician (or, after hours, the
ANATOMIC PATHOLOGIST ON-CALL
is aware that the specimen has been submitted. An on-call
anatomic pathologist is available 24 hours a day, every day of the year,
including weekends and U. S. federal holidays. An instruction manual
for histology and cytology is distributed to the Operating Room Suite,
and to the clinical wards.
Autopsies are performed
on deceased patients with valid documentation every day of the year,
including weekends and U. S. federal holidays.
2. TO LOOK UP AN ANATOMIC PATHOLOGY REPORT (surgical pathology,
cytology, or autopsy report), you must have access to the Veterans Affairs
Computerized Patient Record System (CPRS).
See Appendix 1.1: Getting onto the computer.
Sign onto CPRS with your CPRS Access and Verify codes.
The PATIENT SELECTION window will appear. Enter the patient's name
(middle of window). Click on OK. Click on REPORTS (bottom right
toolbar). Click on ANATOMIC PATHOLOGY REPORTS (middle-left). Click on
SURGICAL PATHOLOGY, CYTOLOGY, or AUTOPSY, as desired.
If the report states: REPORT NOT VERIFIED, then this means that
the specimen has been received in pathology, but the report is not yet
complete. If there is an urgent need for information about the specimen,
then the attending anatomic pathologist (named in the upper-right corner
of the report) should be contacted. After hours, the
anatomic pathologist on-call should be contacted.
If there is no evidence of a report for the specimen, and if one
working-day has elapsed since the specimen was sent to anatomic pathology,
then the pathology department has not received the specimen.
3. The Anatomic Pathology Laboratory is responsible for processing
all tissues obtained at surgery, outpatient clinics, i.e., GI, GU, Dental
and postmortem examinations in this hospital. In addition, we receive
specimens from other federal installations, i.e. Fort Howard and Perry Point.
The work can be categorized as follows:
3.1. Receipt of specimens.
(2,
3).
3.2. Getting on the computer
7).
3.3. Gross examination and description of specimens
(9).
3.4. Processing tissue in Automated Tissue Processor
(12,
13).
3.5. Embedding and cutting of tissue
(16,
18).
3.6. Staining
(49,
51,
52,
55,
56,
69,
72,
81).
3.7. Infection Control Policy.
(36,
136,
213,
216,
217).
3.8. Filing and storage of tissue blocks and slides.
(38).
3.9. Equipment maintenance policies.
(28,
39,
40,
41,
43,
44,
46,
117).
3.10. Surgical Pathology:
(2,
3,
4,
5,
6).
3.11. Gynecologic Cytopathology.
(100,
104,
129,
189).
3.12. Non-gynecologic Cytopathology.
(105,
106,
107,
108).
3.13. Autopsy Pathology:
(202,
203,
204,
205,
206,
207,
208,
209,
210).
3.14. Quality Assurance:
(33,
34,
35,
87,
113,
137,
138).
3.15. Pathology Informatics:
(149,
150,
151,
152,
252).
3.16. Organ-specific Specimen Handling
(161,
162,
163,
164,
165,
166,
167,
168,
169,
170,
171,
172,
173,
174,
175,
176,
177,
178).
3.17. Resident/Professional Education.
(141,
143,
187,
188,
189).
3.18. Pathology Office.
(190,
191,
192,
193,
194,
195,
196,
197,
198,
199).
3.19. Pathology Workload and Billing.
(243,
245).
3.20. Privacy.
(153,
210,
231,
234).
3.21. Material Safety Data Sheets.
(43,
116,
253).
4. WHERE IS THIS DOCUMENT?
A published, Internet version of this document (draft copy only)
is available at URL:
http://www.netautopsy.org/axsop/axsoptoc.htm
5. The Baltimore VAMHCS is the regional VAMC in Maryland
for a nationwide system of 172 VAMCs, that serves five million
honorably-discharged U. S. veterans. The Department of Veterans Affairs
(DVA) is working toward a system of all-computerized medical records.
The Department of Pathology is a leader in the area of medical record
computerization. All final reporting, billing, and quality assurance
activities are managed in the VistA® / CPRS systems. There is an
anatomic pathologist on-call at all times, who may be reached
through the paging operator.
6. The Anatomic Pathology Laboratory is devoted to pathology resident
education and continuing professional education, through quality assurance
processes (Procedures 35,
122,
138), collegial interaction
(Procedures 137, 138),
and focused educational experiences
(Procedures 143, 188,
189).
7. The Division of Anatomic Pathology has sections devoted
to excellence in particular areas of pathology: dermatopathology,
gastrointestinal pathology, gynecologic pathology, and pathology informatics.
8. STANDARDS. Activities in the Department of Pathology comply with
modern standards of Anatomic Pathology Practice, as described below.
The Procedure Manual written according to National Committee
for Clinical Laboratory Standards (NCCLS) specifications, as follows:
8.1. Procedure Number.
8.2. Title.
8.3. Principle of the test.
8.4. Specimen required.
8.5. Reagents, instrumentation.
8.6. Step-by-step description.
8.7. References.
8.8. Author and effective date.
Hoeltge GA, Dynek DA, Delahunty DC, McClatchey KD,
Rabinovitch A, Robinowitz M, Travers EM.
National Committee for Clinical Laboratory Standards (NCCLS).
Clinical Laboratory Technical Procedure Manuals.
Third Edition.
Approved Guideline GP2-A3. December, 1996. vol 16, no 15.
9. The Procedure Manual is prepared in Hypertext MarkUp Language
(HTML), the publication language of the Internet. Parts of the manual
are available in the public domain.
10. All specimens are submitted to the pathology department
with the following documentation:
10.1. Tissue Examination Form.
(U. S. Standard Form 515, USSF515).
10.2. Gynecologic Cytology.
(U. S. Standard Form 541, USSF541).
10.3. Request for Postmortem Examination.
(U. S. Standard Form 523, USSF523).
10.4. VistA® order-entry.
11. Paper documents are mirrored in VistA®/CPRS®
electronic records.
12. Open-source data structure:
12.1. CPRS® on a platform of VistA®.
12.2. VistA® on a platform of VistA® Kernel.
12.3. VistA® Kernel on a platform of VistA® File Manager.
12.4. VistA® File Manager on a platform of MUMPS®.
12.5. MUMPS® on a platform of C.
13. All reports electronically signed
by technologist/pathologtist.
14. There is HIPAA-secure VistA® email
for patient information and notifications.
15. Electronic tracking of
notification,
billing, and
turnaround-time (TAT).
16. Collection of monthly statistics with
spreadsheet and database
17. Monthly Quality Assurance reports to P&LMS staff meeting.
18. Monthly Quality Assurance Reports submitted to the
Invasive Procedure Review Committee (IPRC)
meeting.
19. In surgical pathology, large resections:
TNM staging according to AJCC/UICC, 6th edition.
20. Annual College of American Pathologists
(CAP) inspection.
21. Triennial Joint Commission for Accreditation of Healthcare
Organizations (JCAHO) inspection.
22. Biennial Occupational Safety and Health Administration (OSHA)
inspection.
23. Electronic re-credentialing
of the medical staff.
APPENDIX 1.1: GETTING ONTO THE COMPUTER.
After signing onto a computer workstation with the network
signon and password, the DESKTOP appears.
The Computer Workstation Identifiers appear in the upper-right corner
of the workstation screen. You will be asked this information
if you call the Help Desk.
The START button, on the lower left corner of the screen,
is used to start up all programs, and to log off.
REFERENCES.
1. Berte LM, Charlton BJ, Kirkley B, Schiffgens J,
Wilson JI, Woodcock SM.
Clinical Laboratory Technical Procedure Manuals;
Approved Guideline -- Fourth Edition.
NCCLS Document GP2-A4. 2002;2(5):.
ISBN 1-56238-458-9, 64 pages.
National Committee for Clinical Laboratory Standards (NCCLS).
940 West Valley Road, Suite 1400. Wayne, PA 19087-1898.
... presents the important components of writing and managing procedures
for the clinical laboratory.
2. Hoeltge GA, Dynek DA, Delahunty DC, McClatchey KD,
Rabinovitch A, Robinowitz M, Travers EM.
National Committee for Clinical Laboratory Standards (NCCLS).
Clinical Laboratory Technical Procedure Manuals. Third Edition.
Approved Guideline GP2-A3. 1996;16(15):.
3. Rosai J.
Rosai and Ackerman's Surgical Pathology. Ninth Edition.
St Louis: C.V. Mosby. 2004;:.
ISBN: 0323013422, 3080 pages.
4. Mills SE, Carter D, Greenson JK, Oberman HA,
Reuter VE, Stoler MH, eds.
Sternberg's Diagnostic Surgical Pathology. Fourth Edition.
New York: Lippincott Williams & Wilkins. 2004;:.
ISBN: 0781740517, 3089 pages.