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Criteria for Pathology Review


kholshoe

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Hi everyone,

We have recently been tasked with trying to standardize all our system's subsidiaries in terms of criteria to send peripheral slides back to a pathologist for review.  The overall goal, of course, is to cut down on unnecessary slide reviews being sent back (normals, etc).  Our subsidiary has historically used a very detailed set of guidelines (for example: not just any new anemic patient - but one with a hemoglobin of <6) with values within the rules to drive the criteria.  Most of our sister subsidiaries are using a much more trimmed down set of criteria (for example: anemia, pancytopenia, etc.) without any values present.  It is our lab's feeling that this is very subjective and would likely lead to even MORE slides being sent to a pathologist.  I'd be interested in hearing what other labs do as trying to search for references online has been completely unsuccessful.  I'm thinking perhaps there isn't consensus because it's all really driven by the medical director/pathologist to begin with.  Any thoughts would be appreciated!

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  • 2 weeks later...
On ‎2‎/‎2‎/‎2018 at 10:20 AM, kholshoe said:

Hi everyone,

We have recently been tasked with trying to standardize all our system's subsidiaries in terms of criteria to send peripheral slides back to a pathologist for review.  The overall goal, of course, is to cut down on unnecessary slide reviews being sent back (normals, etc).  Our subsidiary has historically used a very detailed set of guidelines (for example: not just any new anemic patient - but one with a hemoglobin of <6) with values within the rules to drive the criteria.  Most of our sister subsidiaries are using a much more trimmed down set of criteria (for example: anemia, pancytopenia, etc.) without any values present.  It is our lab's feeling that this is very subjective and would likely lead to even MORE slides being sent to a pathologist.  I'd be interested in hearing what other labs do as trying to search for references online has been completely unsuccessful.  I'm thinking perhaps there isn't consensus because it's all really driven by the medical director/pathologist to begin with.  Any thoughts would be appreciated!

Hi kholshoe, I would agree that the slide review criteria is set primarily by the medical director/ pathologist and as each may help to treat varying patient demographics and each pathologist has their own manner of practice, the criteria for the slide review would, indeed, be somewhat subjective. I have practiced in a number of hematology labs with each having their own criteria for slide review based on the practice of the pathologist signing off on the procedure. The establishment of the criteria seems to be mostly a top down decision with some influence by the supervisors who are closer to the actual work flow. In other words, the work flow of the lab, and technical staff practicing, may have some influence on this decision as well.  I hope this helps.

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  • 3 months later...

Is your pathologist in charge of all of the labs in question?  If so, it should be relatively simple (depending on the initial cooperation of the pathologist/director) to come up with criteria.  Once he or she signs off on a set of standards, it will be your job, as a coordinator, to get all the techs on board with it. 

Start by sitting down with your pathologist and find out what they feel should be submitted.  Then write up a preliminary policy.  Keep in mind that it needs to be comprehensive but straight-forward enough so as not to boggle the techs at the various facilities that will have to follow it.  (Ours only takes a few pages -- we also have it boiled down to a single-page "cheat sheet" that is posted in Hema areas.) Then take it back to the pathologist for final approval/revision.  Follow up with the associates.  If some of the techs are  under other managers, make sure you get buy-in from them before you start education.

Scott

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