Pre-analytic error: A significant patient safety risk

Cancer Cytopathology
Yael K HeherPaul A VanderLaan

Abstract

Ancillary testing in cytopathology has grown dramatically over the past decade, enhancing the clinical value of cytology specimens obtained via minimally invasive methods. However, a complex testing landscape brings with it new and emerging risks to patient safety. Recognition of complicated systems issues as well as shared responsibility in process ownership can help to minimize safety risks. Because pre-analytic factors account for the majority of errors in pathology, attention to operational steps (test ordering, specimen collection, specimen transport, specimen accessioning, and specimen processing) is critical for successful quality improvement programs. With increasing technical costs and complexity of many ancillary molecular tests, a growing trend toward send-out testing to centralized reference laboratories poses additional patient safety risks. Given these new realities in cytopathology ancillary testing, a collaborative, team-based approach with all process stakeholders is needed to improve pre-analytic processes, reduce error risk, and enhance patient safety.

References

Aug 23, 2012·American Journal of Clinical Pathology·Richard J Zarbo
Feb 12, 2014·Lung Cancer : Journal of the International Association for the Study of Lung Cancer·Paul A VanderlaanDaniel B Costa
May 13, 2015·Cancer Cytopathology·Paul A VanderLaan
Apr 16, 2016·Archives of Pathology & Laboratory Medicine·Sinchita Roy-ChowdhuriYasushi Yatabe
Jun 23, 2016·Archives of Pathology & Laboratory Medicine·Sinchita Roy-Chowdhuri, John Stewart
May 31, 2017·Archives of Pathology & Laboratory Medicine·Lauren N StuartRaouf E Nakhleh
Jun 14, 2017·Cancer Cytopathology·Maureen F Zakowski
Jan 18, 2018·Archives of Pathology & Laboratory Medicine·Michiya Nishino, Marina Nikiforova

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Citations

May 23, 2019·Cancer Cytopathology·Raghavendra Pillappa, Adele O Kraft
Jun 28, 2019·Archives of Pathology & Laboratory Medicine·Andrew P NorganR Ross Reichard
Jun 17, 2020·Cancer Cytopathology·Yael K Heher
May 11, 2021·American Journal of Medical Quality : the Official Journal of the American College of Medical Quality·Abraham Z Cheloff, Grace C Huang

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