The Bowel Screening Pilot:a pathologist’s perspective

Dr Nicole KramerAnatomic pathologist

LabPlus, Auckland City Hospital

Outline and approach

• Workload experience at LabPlus

• Expected workforce required

• Successes and stumbling blocks

Specimen services

Anatomic pathology

(tissue retrieved at colonoscopy)

Biochemistry(iFOBT)

Workload is for the Waitemata DHB population of 575,000 Additional laboratory workload not accounted for includes testing of patients as inpatients (haematology, biochemistry, microbiology), additional histology specimens and cytogenetics

Specimen services• All specimens are unpacked, checked (labelling, appropriate

request form), scanned and registered with a unique laboratory identifier

• Receive 39,000 iFOBT per annum• Receive 1462 histo cases/year (currently signed straight

through)• Assuming an average of 7 minutes/case

• 4450 hours/year • 87.5 hrs/week• 10% loading for leave (holiday etc.) 2.4 FTE

Chemical Pathology

• 39000 iFOBT specimens/year• Analytical time:

• 2 minutes/case 1300 hrs/year

• 25 hrs/week + 10% loading for leave

• 27.5hrs/week (scientist) = 0.7 FTE

• Chemical pathologist or senior clinical scientist required for oversight and governance for troubleshooting and quality assurance (time not included)

Anatomic pathology (AP) workload – administration and clerical work

Number of pots each month (2014)• Workload is variable• Accounting for highest

potential workload• 10 minutes/case

• 5.6hrs/week• Resections

• .25hrs/cancer• 0.4hr/week

0.17 FTEApril

MayJune

July

August

Septem

ber

October

November

December

January

Febru

aryMarc

h0

20

40

60

80

100

120

140

160

Number of cases received each month (2014 -2015)

Anatomic pathology workload – scientist/histotechnician

• Registration • Grossing/transfers• Embedding• Cutting sections• Quality control• Data collection and submission• 0.7 FTE technical staff

Immunoperoxidase fee 106

2 X Level Fee 12

LVL Level fee 5664

No Charge fee 5

Paraffin Block 5567

recut fee 1

rrw recut fee 2

special stain fee 11

Billing data for 2014

Buesa RJ. Productivity standards for histology laboratories. Annals of Diagnostic Pathology 2014 (2010); 107-24.

AP workload – pathologist: screening

2012 Qtr2

2012 Qtr3

2012 Qtr4

2013 Qtr1

2013 Qtr2

2013 Qtr3

2013 Qtr4

2014 Qtr1

2014 Qtr2

2014 Qtr3

2014 Qtr4

2015 Qtr1

2015 Qtr2

2015 Qtr3

Sum of Number Pots

323 1285 1688 1371 1410 1899 1193 1439 1870 2148 1609 1099 1104 413

Count of Lab Number

102 359 522 431 442 626 383 401 563 733 503 335 350 132

250

750

1250

1750

2250

Qtr2 Qtr3 Qtr4 Qtr1 Qtr2 Qtr3 Qtr4 Qtr1 Qtr2 Qtr3 Qtr4 Qtr1 Qtr2 Qtr32012 2013 2014 2015

2.60

2.70

2.80

2.90

3.00

3.10

3.20

3.30

3.40

3.50

3.60Average of Number Pots

Average of Average Number of Pots

Workload is variable8 minutes /pot – reviewing colonoscopy, reporting, additional sections, peer review 13-17 hrs/week Preparing and presenting at MDM 1hr/weekTroubleshooting, liaising with scientists, clinicians, data reporting, QAP (1-2hr/week)18 to 25hours/week – 0.5 to 0.6 FTE

Average Pots per Case 2012-2015

AP workload – pathologistresections

• 224 cancers in three years• 1.5 cases/week• 1.75 hrs of pathologist time/case• 2.6 hr/week• 0.6 to 0.7 FTE total

Standards and Quality Indicators in order to be able to be audited we may need to have some

additional quality indicators for AP. For example we need to have strong support from the laboratory information system.

Reporting and audit of a number of anatomic pathology quality indicators is desirable

• Extraction of data from reports is hampered by the lack of laboratory information systems support available

and the method by which the reports are generated

• Most recently data has been extracted ‘manually’ as part of an audit process

Summary

Expected FTEs for the current population screened at WDHB are estimated at: Specimen services – 2.4 FTE Chemical pathology – 0.7 FTE with oversight Anatomic pathology

Administration – 0.2 FTE Scientist/technicians – 0.7 FTE Pathologists – 0.6 - 0.7 FTE

Workload is variable and recruitment of an appropriate staff mix is required