Post on 15-Dec-2015
Reduction In Slide Label Mis-Identifications Due To Implementation Of 2 Dimensional Bar Coding In The
Anatomic Pathology Laboratory At A Tertiary Care Hospital
Session 3, St. GeorgePathology Informatics 2010
September 20, 2010
Gaurav Sharma, Bryan J Dangott, Anthony Piccoli
Luke T Wiehagen, Susan M Kelly, William R StewartSamuel A Yousem, Liron Pantanowitz, Anil V Parwani.
Department of PathologyUniversity of Pittsburgh Medical CenterPittsburgh, Pennsylvania, United States
Email: sharmag@upmc.edu
BackgroundBarcoding in AP labs
IdentificationWorkflowTracking
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.”
Received Accessioned
CassettesVerified
TissueEmbedded
Blocksprocessed
Slide(s)made
CoverslipVerify
Slides sent to Pathologist
Grossed& CassettesSubmitted
ContainerRequisition
Hand Labeled
CassettesHand Labeled
SlideLabelsPrinted
Manual entry or retrieval of case #
Workflow-Pre Barcoding Implementation
Gro
ss
Ro
om
His
tolo
gy
Workflow-Post Barcoding Implementation
Received Accessioned
CassettesVerified
TissueEmbedded
Blocksprocessed
Slide(s)made
StainedCover-slip
Verified
Slides sent to Pathologist
Grossed& Cassettes(Barcode)
ContainerBarcode
Case detailsEntered
SlideLabelsPrinted
Gro
ss
Ro
om
His
tolo
gy
TechnologyLaboratory 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).
Design2 D Datamatrix
Vendor: General DataBlocksSlides
Barcode scanners:Accessioning areaGross RoomHistology RoomPathologist Offices
Barcode printers (cassettes): Gross RoomBarcode printers (slides) : Histology Room
CassetteEngraver
Microtomy
*Order secondary stainsor annotate blocks*
*VERIFY blockspost-embedding*Processor
Embedding
*PRINT labels orqueue slide engraving*
*Track blocks pre/post-processing*
Cassette FileLabel printer
Final distribution
Staining
*VERIFY slidesprior to distribution*
*Stain code id’edby stain processor*
Case review & Sign out
Label printer
*OPEN specimen orvalidate againstbar-coded report*ORDER recuts/stains
Slide File
Results Slide label mis-identification/SHY
-1
0
1
2
3
4
5
6
7
8
9
10
2007
-03
2007
-05
2007
-07
2007
-09
2007
-11
2008
-01
2008
-03
2008
-05
2008
-07
2008
-09
2008
-11
2009
-01
2009
-03
2009
-05
2009
-07
2009
-09
2009
-11
2010
-01
2010
-03
2010
-05
Month-Year
Slid
es/m
onth
Pre-implementation (2.5/m) Implementation (0.5 cases/m) Post-implementation (0.58 cases/m)
DefectsCauses
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 entryPersonnel issues, not related to barcode technologyCytology blocks to be barcoded
ResultsAs a technologyComplex
Multi-step process integrationFactor in LIS updates and compatibilityNovel tracking solutions had to be designed
ImplementationMust be well planned with input from vendorsAdequate resource and time must be committedEquipment procurement/installation takes timeDowntime procedures must be written up
ConclusionsAnatomic 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 benefitsReal time status tracking
Containers, blocks, slides etc.Case can be tracked with better accuracyA tracking tool (Advanced Barcode & Tracking) was co-
developed with the vendor
Digital Pathology workflowBarcode protocols can be extended to images for definite
image and specimen identification