Pathology management of clinical business collection

Pathology management is a commonly used functional module in Internet medicine, because the particularity of its process requires high proficiency in business. In this article, the author shares his experience and hopes to help everyone.

With the progress of science and technology and the improvement of medical informatization, pathological examination has also been widely used in clinical work and clinical research, and the management of the whole process of pathology has gradually reached the goal of digitalization and intelligence.

1. Overview of pathological management

Definition of pathological examination

I don't know if you have heard the doctor say to do a biopsy when you visit the hospital, if you haven't heard it so far, then congratulations, you or someone close to you has not been at risk of getting a tumor so far, yes, pathological examination is one of the most important and accurate methods for tumor diagnosis.

The official interpretation of pathological examination is a pathological morphological method used to examine pathological changes in organs, tissues or cells of the body. Generally speaking, it is to cut a certain size of diseased tissue from the human body, section it by pathological histology, and examine the lesion with a microscope to obtain a pathological report and pathological diagnosis.

Type of pathological examination diagnosis

Common pathological findings include:

1. Cytology (exfoliated cells): For example, the use of vaginal discharge can be used to diagnose cervical cancer, and more and more physical examination institutions will also include this pathological examination; In addition, sputum smears can also be used to diagnose lung cancer, and others include nasopharyngeal cancer, esophageal cancer, gastric cancer, etc.
2. Conventional pathology (biopsy): pathological specimens are generally obtained through puncture, surgery or endoscopy, so as to diagnose bone and soft tissue tumors, digestive tract tumors, etc.
3. Intraoperative freezing: As the name suggests, the frozen pathological specimens produced during the operation can quickly determine the nature of the lesion, which often affects the operation of the operation, therefore, for this type of pathology, a report needs to be issued within 30 minutes, while other reports are generally issued within 2-5 days.
4. Genetic testing: relatively new technology, some hospitals have separate management, and some hospitals will be together with pathological examination. Common examples include bone marrow fluid extraction for leukemia diagnosis.

Pathology management

Before talking about pathological management, it is necessary to understand the objects involved in management, including patients, clinical/medical/operational/physical examination departments and pathology departments:

• The clinical/medical/operational/physical examination department needs to obtain pathological specimens from patients and fill in the pathology application form;
• After the clinical/medical/operational/physical examination department obtains the specimens, the specimens need to be sent to the pathology department by the transportation workers;
• The pathology department receives the specimens for pathological diagnosis, and finally issues a pathology report to the clinician, who then makes a clinical diagnosis.

According to the above process, the scope of pathological management is analyzed:

• Management of pathology projects: management of pathology projects for different types of pathological diagnosis, including their charging rules;
• Management of pathology application forms: Different pathology application forms are corresponding to different pathological diagnosis types, and all completed application forms in the hospital can be queried;
• Management of pathological specimens: The most important part of pathological management, the loss of pathological specimens is also a very serious adverse event in the hospital; The status of pathological specimens can be checked instantly, and the historical operation process can be traced, and the whole process can be tracked;
• Management of pathology reports: pathology departments and clinical departments can inquire about the pathology reports issued; In particular, the intraoperative freezing report during the operation can obtain the pathology report within 30 minutes;

2. Product design

How to design products for the whole process management of pathology?

Pathology project management

There are several important definitions in pathology project management:

1. Item classification and sub-classification: pathology items are often managed as a category of diagnosis and treatment items, and pathology and bone marrow are managed for genetic testing and distinguishable items.

2. Informed consent: For the implementation of the project, patients or family members need to sign the informed consent form, and it needs to be maintained in advance during project management, and multiple copies need to be supported.

3. Definition of pathology application form: Define the pathology application form that needs to be filled in to issue the project, covering the type of application form and the name of the application project.

4. Whether the pathology application is defined: For the synchronous need to do pathology for examination items such as gastroscopy and colonoscopy, it is necessary to mark whether it is a pathological examination on the maintenance of the examination items, and if it is a pathological examination, it is the same as the pathological examination in the diagnosis and treatment items, and the pathology application form needs to be defined.

Pathologist's order & application form issuance

1. After sorting out the items and examinations that can be prescribed pathology, it is necessary to sort out the pathological instructions synchronously, and in order to facilitate the issuance of pathological orders with doctors, the management of pathological orders is often carried out, that is, the defined pathological items are classified and managed.

2. After classification, when the doctor issues a pathological order, the corresponding items can be quickly found and issued according to the set classification, and it should be noted that the status of the application form should be marked on the issued medical order. The source of the doctor's order can be outpatient, inpatient, emergency, observation of the patient's treatment process, physical examination process, surgical process, medical technology examination process, etc.

3. The definition of the application form plays a role at this moment when checking the project management, through the issued doctor's order item, the doctor needs to fill in the corresponding application form, different pathological types and the gender of the patient will correspond to the application form with different contents, the application form is associated with the corresponding pathological specimen, and the status of the pathological specimen will determine the status of the application form. In order to improve the efficiency of doctors' filling, the design needs to pay attention to the following:

• The inspection index items automatically obtain valid results;
• The patient's medical history is automatically synchronized from the medical record of this visit;
• Each application form should specify the doctor and department that will be sent for testing;

Pathology specimen management

Different hospitals may have different granularity for pathological specimen management, but there will be no lack of key links such as application, receiving, registration and reporting.

1) Application: the initial status of the specimen, the default status after adding the pathological specimen when filling in the application form; A unique identification number for this specimen - the specimen number will be generated at the time of application.

2) Collection: Some hospitals do not produce real specimens by filling in the application form, and need to mark the real production of specimens by the collection status; When applying for or collecting specimens, pathological labels carrying specimen numbers and specimen number barcodes can be printed, and the current process node and subsequent process nodes can be scanned by the code scanner to identify the specimen and perform corresponding operations;

3) Fixation: Only the routine specimens generated at night in the operating room are fixed by the nurses in the operating room;

4) Verification: Only the routine specimens produced at night in the operating room will be checked by the nurses in the operating room for multiple times;

5) Delivery: After obtaining the specimen, the specimen needs to be sent to the pathology department for pathology clinic, and the clinical/medical technology/surgery/physical examination department will mark the specimen in the state of sending it out;

6) Receiving: The Department of Pathology receives the sent specimens, performs the receiving operation, and classifies the specimens. Received specimens cannot be cancelled in the pre-process; The receipt of pathology specimens will also affect the status change of pathology application form.

7) Registration: After receiving the specimens in the receiving room/freezing room of the pathology department, the specimen registration is carried out, and the medical record number is generated for the registration of pathological reports. The system for issuing pathology reports is relatively professional, such as Langjia's technical process management and digital pathological imaging, and the clinical system is often integrated with the tripartite pathology report system through the registration environment, and after the specimen is registered, pathology personnel can continue to use the tripartite system to dehydrate, section, stain and other work of pathological specimens.

• In the actual scenario, the pathology department will select a pathology number to occupy according to the specimen pathology library, specimen type and the specimen actually obtained, and at this time, the product design needs to support batch selection of received specimens, define the starting number segment, and carry out specimen registration.
• In addition to the registration of specimens in the hospital, it is also necessary to support the manual registration of pathological specimens, on the one hand, in order to directly carry out manual registration in case of emergencies to ensure that the process is not blocked, and on the other hand, it also supports the testing of specimens sent from other hospitals;

8) Report: After the pathology department issues the pathology report, the status of the pathological specimen is updated to report, which means that the process of the pathological specimen is over. At present, many AI applications have been applied to the pathological diagnosis process, such as doctors using voice recognition technology to record pathological diagnosis information, and intelligent assisted screening of slice images of lung cancer, cervical cancer, and breast cancer.

In the process of specimen management, the change records of the current and historical status of the corresponding specimen can be traced at any time, including the nodes experienced, the operator of each node, the department of operation, and the time of operation.

Pathology report inquiry

Pathology report inquiries can be divided into:

1) Medical pathology report inquiry: After the pathology report is issued, clinicians and nurses can query the report results in the pathology report in the patient's current visit record, and the doctor can make a clinical diagnosis based on the pathological diagnosis; If it involves critical values, the results can also be queried synchronously;

2) Operating room freezing report query: As mentioned above, the operating room freezing report needs to issue the results within 30 minutes, and the surgical nursing function has a pathological freezing query list, and the background automatically refreshes the list regularly to obtain the latest freezing report results;

3) Patient report inquiry: Patient report inquiry can be divided into paper inquiry & electronic query.

• Paper version inquiry: Patients can print the paper report of pathology through the self-service machine in the hospital or obtain the printed paper report from clinicians and nurses;
• Electronic version query: It depends on the degree of the hospital's smart hospital, and you can generally query the individual's pathology report from the applet or the official account;

Statistics of pathological indicators

There are several main aspects of pathological index control:

1. Proportion of unqualified specimens: Unqualified specimens will affect the accuracy of pathological diagnosis, so the proportion of unqualified specimens should be reflected in the statistics of pathological indicators, and the application departments and applicants of specimens can be distinguished.

2. Report issuance time: on the one hand, it is necessary to control the timeliness of the frozen report issuance in the operating room, and on the other hand, to control the efficiency of the overall report issuance in the hospital.

3. Compliance of specimen management: The main control is whether the status change of specimens from application to report room is in line with the management regulations of the hospital, such as specimens in the operating room at night are not fixed and verified according to regulations.

III. Conclusion

Due to the seriousness of pathological diagnosis, the design of pathological products also needs to be more detailed and rigorous, and it has made great breakthroughs in clinical application, scientific research and digitalization. Finally, I wish all readers good health and no need to have relevant experiences and experiences.

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