Leveraging preprocessor scanning to improve patient safety, quality, and lean workflow in the anatomic pathology lab

Challenge

Address the last missing piece for sample tracking in the AP workflow at Pathologists Bio-Medical (PBM) 
PathGroup: sample pre-processing

Background

Approach/Goals

Three primary goals in implementation of the new workflow and system.

• Support future growth – Sample tracking is important to determine how to better apply lean principles. Further, labor shortages impacting the AP segment mean staff must be better utilized.
• Improve quality – Ensuring sample quality is increasingly important in AP, and researching quality issues in preanalytics is time consuming. Data and traceability of samples at preprocessing was needed to reduce the potential for compromised, lost, or misplaced samples.
• Advance lab safety – Data about samples at preprocessing could reduce the potential for compromised, lost, or misplaced samples. However this needed to be complementary to the existing workflow.

Results

• The Hydra optimization phase lasted for about seven weeks. While the initial scanning of cassettes took longer than the prior method using a digital camera, the benefit of Hydra was that cassette data was immediately available for use rather than requiring manual interpretation of the digital image.
• Shortly after full implementation of Hydra into their workflow, the lab staff experienced three events where the Hydra system data and new workflow demonstrated value.
  • Missing cassette at preprocessing: A missing cassette on a large case was reported. In searching the archived lab video footage of when the cassette should have been processed, the lab staff was still unable to locate the missing cassette. However, when the Hydra power user accessed the Hydra system data, she realized that the cassette had never been through the Hydra system. This immediately narrowed the search area for the missing cassette to preprocessing. As a result, the missing cassette was quickly recovered and expedited through the diagnostic process.
  • Missing cassette at post-processing: A block that was scanned on Hydra was never scanned at embedding and was subsequently identified as missing. This immediately narrowed the search area for the missing cassette to post processing. The investigation revealed that when a technician was unloading a basket from a tissue processor, they dropped the basket and the missing cassette was dropped on the floor. (It was actuallyfound under the tissue processor.)
  • Impact of improper processing: When a tissue sample did not survive processing, Hydra data was accessed in order to troubleshoot. The processor used to process the sample was easily identified with Hydra data. Lab staff measured the alcohol concentrations on the processor with a hydrometer, which revealed that one of the alcohols was outside of the concentration on the screen display. Hydra data also revealed that the sample was assigned a longer than necessary protocol, contributing to the loss.
• Each of these investigations took the lab staff 15 – 20 minutes, whereas they would have been 3-4 hour efforts without the Hydra system and data. These investigations led to valuable insights in how to improve lab processes further.

Conclusion