Transcript Reduction In Slide Label Mis-Identifications Due To Implementation

Gaurav Sharma, Bryan J Dangott, Anthony Piccoli
Luke T Wiehagen, Susan M Kelly, William R Stewart
Samuel A Yousem, Liron Pantanowitz, Anil V Parwani.
Department of Pathology
University of Pittsburgh Medical Center
Pittsburgh, Pennsylvania, United States
Email: [email protected]
Background
 Barcoding in AP labs
 Identification
 Workflow
 Tracking
 UPMC histology bar-coding project has evolved from Pittsburgh
Regional Healthcare Initiative (PRHI)

PRHI Executive Summary (August 2004) :
Moving towards one-by-one processing at UPMC Shadyside
“Because the team would be using techniques adopted from the Toyota
Production System (TPS), and because histology, the midpoint of the work,
operated something like an assembly line, the decision was made to begin
there. Eventually, the goal is to make the entire process—from the Gross
Room to the pathologist’s interpretation—one continuous flow process.”
Histology
Gross Room
Workflow-Pre Barcoding Implementation
Received
Accessioned
Container
Requisition
Hand Labeled
Coverslip
Verify
Slide
Labels
Printed
Blocks
processed
Slide(s)
made
Slides sent to
Pathologist
Cassettes
Hand Labeled
Tissue
Embedded
Grossed
& Cassettes
Submitted
Cassettes
Verified
Manual entry or retrieval of case #
Histology
Gross Room
Workflow-Post Barcoding Implementation
Received
Accessioned
Container
Barcode
Stained
Cover-slip
Verified
Slide
Labels
Printed
Blocks
processed
Slide(s)
made
Slides sent to
Pathologist
Case details
Entered
Grossed
& Cassettes
(Barcode)
Tissue
Embedded
Cassettes
Verified
Technology
 Laboratory information system-CoPath version 3.2 with
workflow and tracking system-CoPath Plus Advanced
Barcoding and Tracking (Cerner DHT, Kansas City, MO)
 Barcode cassette printers-Shandon Microwriter (Thermo
Scientific, Waltham, MA) and GDKV2-C (General Data
Corporation, Cincinnati, OH)
 Thermal slide label printers-Cognitive Cxi (CognitiveTPG,
Lincolnshire, IL) using chemical resistant adhesive labels StainerShield XT(General Data Corporation, Cincinnati)
 Barcode scanners-Symbol DS 6607 and 6707 (Motorola
Corporation, Schaumburg, IL).
Design
 2 D Datamatrix
 Vendor: General Data
 Blocks
 Slides
 Barcode scanners:
 Accessioning area
 Gross Room
 Histology Room
 Pathologist Offices
 Barcode printers (cassettes): Gross Room
 Barcode printers (slides) : Histology Room
*Order secondary stains
or annotate blocks*
Cassette
Engraver
Processor
*VERIFY blocks
post-embedding*
Embedding
*Track blocks pre/
post-processing*
Microtomy
*PRINT labels or
queue slide engraving*
Cassette File
Label
printer
Label printer
Staining
Final distribution
Case review & Sign out
Slide File
*Stain code id’ed
by stain processor*
*VERIFY slides
prior to distribution*
*OPEN specimen or
validate against
bar-coded report
*ORDER recuts/stains
20
07
-0
20 3
07
-0
20 5
07
-0
20 7
07
-0
20 9
07
-1
20 1
08
-0
20 1
08
-0
20 3
08
-0
20 5
08
-0
20 7
08
-0
20 9
08
-1
20 1
09
-0
20 1
09
-0
20 3
09
-0
20 5
09
-0
20 7
09
-0
20 9
09
-1
20 1
10
-0
20 1
10
-0
20 3
10
-0
5
Slides/month
Results
Slide label mis-identification/SHY
10
Pre-implementation (2.5/m)
Implementation (0.5 cases/m)
-1
Month-Year
Post-implementation (0.58
cases/m)
9
8
7
6
5
4
3
2
1
0
Defects
 Causes
 Pre-barcode

Manual entry of case numbers
 Post-barcode
 Tissue curl (from preceding case) picked up
 Cytology blocks not barcoded
 Resolution (recent cases)
 Recently, issues are not related to manual case entry
 Personnel issues, not related to barcode technology
 Cytology blocks to be barcoded
Results
As a technology
 Complex
 Multi-step process integration
 Factor in LIS updates and compatibility
 Novel tracking solutions had to be designed
 Implementation
 Must be well planned with input from vendors
 Adequate resource and time must be committed
 Equipment procurement/installation takes time
 Downtime procedures must be written up
Conclusions
 Anatomic pathology specimen identification systems such
as 2D barcoding and associated tracking tools can help
significantly reduce mislabeling errors in the pathology
laboratory and thus improve patient safety.
Other benefits
 Real time status tracking
 Containers, blocks, slides etc.
 Case can be tracked with better accuracy
 A tracking tool (Advanced Barcode & Tracking) was codeveloped with the vendor
 Digital Pathology workflow
 Barcode protocols can be extended to images for definite
image and specimen identification
http://www.neatorama.com/images/2005-11/zebra-barcode.jpg
Thank you