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

http://www.neatorama.com/images/2005-11/zebra-barcode.jpg

Thank you