Quality Improvement in the Anatomic Pathology Laboratory

Patel, S., Smith, J. B., Kurbatova, E., & Guarner, J. (2012). Factors that impact turnaround time of surgical pathology specimens in an academic institution. Human Pathology, 43(9), 1501-1505. 

Customer satisfaction depends on the processing time of the test results. The purpose of the study was to find factors that affect the processing time of non-biopsy surgical pathological specimens. The study provided calculations of the time required from receipt of all surgical specimens except biopsy to review of results over a two-week period. Tissue type slides number per case, discussions with pathologists, immunohistochemistry, decalcification, and diagnosis were examined. Patel et al. performed both the multivariate and univariate analyses. Seven hundred thirteen samples were tested, 551 were confirmed within two days, and 162 lasted for more than three days. Lung, udder, gastrointestinal, and genitourinary samples had the highest proportion of deregistered cases over three days. In univariate studies, the malignancies diagnosis, consultation with additional pathologists, the use of frozen sections, and immunohistochemical staining were all primarily associated with increased treatment time. This study is important for the topic since, in order to improve quality in the anatomic pathology laboratory, researchers and practitioners first should identify factors influencing specimens.

Tworek, J. A., Volmar, K. E., McCall, S. J., Bashleben, C. P., & Howanitz, P. J. (2014). Q-Probes studies in anatomic pathology: quality improvement through targeted benchmarking. Archives of Pathology & Laboratory Medicine, 138(9), 1156-1166. 

The American University of Pathologists established the Program of Q-Probes in 1989 as a peer-reviewed quality assurance service. The objective of the study is to establish a national benchmark of the anatomical pathology for specific quality indicators at specific points in time. The design included Q-Probes that are funded through a one-time, voluntary subscription to a particular study. The study covered hospital laboratories in the United States, Canada, and sixteen other countries. AP metrics are mentioned in about one-third of the Q-Probes surveys. All QProbes surveys include key quality indicators and a number of ancillary indicators.

The results of the study show that there were fifty-two anatomical probes studies that address the outcomes of the process and issues related to quality assurance. The studies demonstrated a standardized benchmark for particular discipline metrics of cytopathology, autopsy pathology, and surgical pathology. These studies represented the laboratory performance improvement among the national spectrum. Tworek et al. concluded that in the areas of cytopathology, surgical pathology, and postmortem pathology, the QProbes initiative had created an important national benchmark in AP that addresses pre-analytical, analytical, and post-analytical aspects. This study has relevance to the topic because implementing targeted benchmarking could contribute to the quality improvement in the anatomic pathology laboratory, and the study demonstrated the approach’s applicability.

Sayed, S., Cherniak, W., Lawler, M., Tan, S. Y., El Sadr, W., Wolf, N., Silkensen, S., Brand, N., Meng, L., Pai, S., Wilson, M., Milner, D., Flanigan, J. & Fleming, K. A. (2018). Improving pathology and laboratory medicine in low-income and middle-income countries: roadmap to solutions. The Lancet, 391(10133), 1939-1952. 

Efforts to improve pathology and laboratory medicine in low- and middle-income countries are due to a lack of awareness and investment in the importance of pathology and laboratory medicine for health systems that function at the political and state levels. It was local, fragmented, and almost unsustainable. Addressing four key challenges in providing pathology and laboratory medicine services were described in the first section of the study. The second section of this paper proposes feasible remedies for middle- and low-income countries.

Developing and maintaining high-quality pathology and laboratory medicine staff requires access to mentoring and ongoing professional development, division of labor, and short-term visit programs. Opportunities to improve training for pathologists and related pathology and laboratory medicine personnel by expanding and enhancing training opportunities need to be investigated and leveraged. The pathology and laboratory medicine infrastructure needs to be improved by eliminating supply chain bottlenecks and increasing the availability of laboratory information systems. Improving pathology and laboratory medicine may create some challenges since it requires different financial and professional resources. For this reason, the study handled by Sayed et al. is crucial since it demonstrates the role of the county’s economic status in the anatomic pathology laboratory quality improvement issue.

Nakhleh, R. E., Nosé, V., Colasacco, C., Fatheree, L. A., Lillemoe, T. J., McCrory, D. C., Meier, F., Otis, K., Owens, S., Raab, S., Turner, R., Ventura, K. & Renshaw, A. A. (2016). Interpretive diagnostic error reduction in surgical pathology and cytology: guideline from the College of American Pathologists Pathology and Laboratory Quality Center and the Association of Directors of Anatomic and Surgical Pathology. Archives of Pathology & Laboratory Medicine, 140(1), 29-40. 

In collaboration with the Association of Directors of Anatomy and Surgical Pathology, the University of the American Pathologist Pathology and Laboratory Quality Center has established evidence-based guidelines to define the role of case reporting in surgical pathology and cytology. The researchers have convened a panel of experts to develop. A literature search was performed to obtain information on case reviews in surgical pathology and cytology. Because case reviews have been shown to reveal errors, expert committees have found inconsistencies and potential misconceptions for anatomical pathologists to use the Pathology Case Review Protocol to improve the quality of patient care. Clinical correlations, standardization of diagnostic criteria, classification methods, and confirmatory trials have been shown to improve the accuracy of surgical pathology and cytological diagnosis in studies. Error reduction is one of the key objectives in the context of anatomic pathology laboratory quality improvement. The study provides the information in the form of guidelines which makes the study more applicable and assessable.

Banks, P., Brown, R., Laslowski, A., Daniels, Y., Branton, P., Carpenter, J., Zarbo, R., Forsyth, R., Liu, Y., Kohl, S., Diebold, J., Masuda, S., Plummer, T. & Dennis, E. (2017). A proposed set of metrics to reduce patient safety risk from within the anatomic pathology laboratory. Laboratory Medicine, 48(2), 195-201. 

The anatomical pathology laboratory workflow consists of three key steps in sample processing. The pre-analysis, analysis, and post-analysis phases of the workflow include multi-step subprocesses that have a significant impact on patient care. A group of experts from around the world has come together to develop a set of criteria that laboratories around the world need to use as the basis for analyzing and improving sample processing to reduce patient safety risks. Members of the Institute for Anatomical Pathology for Patient Safety have pooled their knowledge to create a set of indicators that identify processes that are at high or low risk of causing negative patient consequences. Steps related to the risk of sample misidentification fall into the high-risk category and require more attention in the quality management system. For example, workflow measures related to operational efficiency are considered low risk. The study provides important data on the metrics for reducing risks associated with patient safety in the anatomic pathology laboratory. It is highly relevant information that could be used in practice for monitoring the turnaround times for surgical specimens.

Volmar, K. E., Idowu, M. O., Souers, R. J., Karcher, D. S., & Nakhleh, R. E. (2015). Turnaround time for large or complex specimens in surgical pathology: A College of American Pathologists Q-Probes study of 56 institutions. Archives of Pathology and Laboratory Medicine, 139(2), 171-177. 

The turnaround time of large or complex surgical pathological specimens is a measure of the efficiency of anatomical pathology and can affect the coordination of patient care. The purpose of this study is to establish a TAT benchmark and identify practical aspects that may affect TAT. Participants in the QProbes Quality Improvement Program at the College of American Pathologists analyzed all surgical pathology cases over the past six months and found up to 50 cases identified by the current procedural term code 88307 or 88309. The date and time of participation and final deregistration were created by reported participants. The study backups the data with the long-time experience outcome, which makes it credible and deserving to be studied.

Tseng, C. E., Chiang, H. H., Shih, L. Y., & Liao, K. S. (2014). The feasibility of computer-aided monitoring of the workflow in surgical pathology: A five-year experience. Journal of Medical Systems, 38(2), 1-8. 

The purpose of this study was to investigate whether computerized workflow monitoring could be used in surgical pathology. Tseng et al. analyzed four subprocesses of the pathological surgical process. From the planning of pathological surgical examinations to the receipt of examination sheets and samples by the laboratory. From receiving samples to issuing pathology reports. From issuing pathology reports to automatic computer forwarding of positive pathology reports by email to the doctor who referred the patient. Computer-aided monitoring might have great opportunities in addressing the issue of quality improvement in anatomic pathology because monitoring specimens might highly benefit from the computer intervention.

Smith, M. L., Wilkerson, T., Grzybicki, D. M., & Raab, S. S. (2012). The effect of a Lean quality improvement implementation program on surgical pathology specimen accessioning and gross preparation error frequency. American Journal of Clinical Pathology, 138(3), 367-373. 

Few studies have shown that improving lean quality can improve patient safety in anatomical pathology. In the field of hospitalization and macroscopic examination of the anatomical pathology laboratory, lean teaching methods, goal setting and cultural change of policy management, Kaizen events, observation of work activities, takeover and pathways, A3 problem solving, metric development, and For frontline work using measurement, and redesign. The study analyzed the percentage of near misses and adjustments in a particular work process before and after a lean application. During the deployment phase, researchers documented 29 individual cause assessments for A3. The lean quality improvement primarily described in the study is one of the possible solutions for the anatomic pathology laboratory quality improvement.

Emmanuel, I., Abaniwo, S., Nzekwe, P., Richard, S. K., Abobarin, O., Longwap, A., & Joseph, A. (2020). Laboratory turnaround time of surgical biopsies at a histopathology service in Nigeria. Nigerian Medical Journal: Journal of the Nigeria Medical Association, 61(4), 180.

The time between receiving a sample in the lab and providing a report for collection and shipping is called the lab lead time. This is an important part of lab quality control and is highlighted as a key performance indicator of lab performance. The purpose of this study is to assess the lead time in our histology and compare the results with the results of other studies. Regarding timeliness, Emmanuel et al. Require the histological laboratory to set realistic goals. This should be checked regularly to check compliance and improve the quality of service in this area. The main advantage of the study is that it considers a specific example of the country, which helps to evaluate the problem status and solution according to different factors such as economic and social status of the country, the level of the medicine in the country, and its future prospectives.

Dinsmore, C. (2012). Development and Validation of a Predictive Model for Turnaround Time of Anatomic Pathology Specimens. Department of Computing and Digital Media DePaul University.

The Institute of Anatomical Pathology strives to accurately predict the time it takes to process the process from ingestion of the surgical specimen to assembly of the housing. The purpose of this study is to investigate which aspects of the histological process affect processing time and to develop predictive models for estimating processing time after receiving a sample. Data from five laboratories using the VANTAGE system were collected for a total of 1,134,766 samples over a 2.5-year period from July 2010 to January 2012, using linear regression, categorical regression, and principal component analysis was handled. A model for predicting sample cycle time was created and validated with a 60% accuracy rate. The study is highly relevant to the topic because it assesses a predictive model for anatomic pathology specimens’ turnaround time. It provides an additional approach to the quality improvement solution and demonstrates the validation of the model.

Dietz, R. L., & Pantanowitz, L. (2019). The future of anatomic pathology: Deus ex machina. Journal of Medical Artificial Intelligence, 2(4), 1-5. 

While the institute has long sought an automated solution for anatomical pathology, the 2017 FDA approval of the Philips IntelliSite Pathology Solution for the primary evaluation and interpretation of formalin-fixed surgical pathology specimens has sparked new interest. This long-awaited permission has increased the number of full-scale scans and AI startups around the world to process the vast amounts of data created by digitizing slides. Pathology AI startups have focused on screening, quality assurance, prognosis, and even detection in addition to diagnosis. For example, lymphocyte infiltration patterns have been shown to provide patients with predictive and therapeutic information. Pathologists are more likely to use applications that are easy to use, affordable, perform well, and have a positive impact. The study plays a crucial role for the topic research because it is essential to address not only the current situation and historical data but also consider the future possibilities and threats.

Mahmoud, A., & Bennett, M. (2015). Introducing 3-dimensional printing of a human anatomic pathology specimen: potential benefits for undergraduate and postgraduate education and anatomic pathology practice. Archives of Pathology & Laboratory Medicine, 139(8), 1048-1051. 

A rapidly evolving technology, 3D printing is widely used in engineering and architecture. 3D printing has recently been introduced into medical practice, especially in reconstructive surgery and clinical research. Anatomical and autopsy specimens printed in three dimensions can be used to show pathological entities for medical, dental, and biomedicine students. 3D printing is used in anatomical pathology for education, training, and clinical correlation. Pancreaticoduodenectomy and definitive nephrectomy specimens were one of the three-dimensionally printed replicas of the anatomical, pathological specimens generated. The model showed the topographical structure of the selected specimen and showed the anatomical relationship between the resected lesion and the adjacent normal tissue. Human anatomical pathology samples can be printed in three dimensions. Advances in 3D printing technology can further improve the quality of 3D printable anatomical, pathological specimens. When discussing the ways to improve the quality of the anatomic pathology laboratory specimens, it is crucial to address the application of the innovative technology. The study provides the implementation of the 3D technology and its benefits.

Lou, J. J., Mirsadraei, L., Sanchez, D. E., Wilson, R. W., Shabihkhani, M., Lucey, G. M., Wei, B., Singer E., Mareninov, S. & Yong, W. H. (2014). A review of room temperature storage of biospecimen tissue and nucleic acids for anatomic pathology laboratories and biorepositories. Clinical Biochemistry, 47(4-5), 267-273.

Frozen biosamples containing well-preserved nucleic acids and proteins are essential for translational research. Frozen biosamples, on the other hand, pose significant risks to space, financial and environmental issues, as well as freezer failures. The purpose of this study was to assess the current state of storage of biosamples at room temperature. To find relevant material, researchers used Pubmed and the provider’s website. As the need for targeted therapies increases and resources diminish, the biomedical community can potentially save money by developing robust long-term tissue preservation techniques for room-temperature biological samples. Room temperature is one of the factors that need to be taken into consideration when addressing the topic. The study provides a useful explanation of the reasons for that, and thus, the work appears highly relevant.

Hanna, M. G., Ahmed, I., Nine, J., Prajapati, S., & Pantanowitz, L. (2018). Augmented reality technology using Microsoft HoloLens in anatomic pathology. Archives of Pathology & Laboratory Medicine, 142(5), 638-644. 

Augmented reality (AR) gadgets like Microsoft HoloLens are not well accepted in the medical industry. Find out how well HoloLens works in both clinical and non-clinical pathology. Virtual annotations during the autopsy, examination of 3D macro and neuropathology samples, examination of complete slide images, distance pathology, and real-time pathology-radiology correlations were all tested at Microsoft HoloLens. Pathology residents using HoloLens is a state-of-the-art augmented reality device with numerous clinical and non-clinical applications in pathology. The device was easy to use, comfortable to wear, had sufficient computer power, and was able to enable high-resolution images. It was ideal for digital pathology and was effective for autopsy, macroscopic and microscopic examinations. Remote monitoring and annotation, viewing and manipulating 3D images, remote pathology in mixed reality, and real-time pathology-radiology correlation is several unique applications. The study provides another innovative technology HoloLens that might contribute to the anatomic pathology laboratory improvement.

Henricks, W. H. (2016). Laboratory information systems. Clinics in Laboratory Medicine, 36(1), 1-11. 

Laboratory Information Systems (LIS) is used by pathologists and pathologists to support their work and ultimately carry outpatient care missions. The latest LIS consists of a complex network of interconnected computer applications and infrastructure to support a number of laboratory information processing requirements. Today’s medicine, as well as the anatomic pathology area, is bound to information technology. That is why the evaluation of the study might contribute to the quality improvement issue and form a new perspective on the problem solution.