[1666] A Cost Efficient Strategy for Deeper Levels on Skin Specimens

AL Wilson, B Nash, WG Watkin. Evanston Hospital, NorthShore University HealthSystem, Evanston, IL

Background: The optimal number of levels to perform on skin biopsy specimens to reduce turnaround time and minimize cost has yet to be determined. In a previous study, we found that small specimen size (0.5 cm or less), punch biopsies, and those with a clinical impression of cancer or dysplasia were more likely than other specimen types to require deeper levels to arrive at a final diagnosis. In this study we examine a strategy aimed at optimizing efficiency in the handling of skin biopsy specimens.
Design: 199 consecutively accessioned skin biopsy specimens which measured 0.5 cm or less or were punch biopsies formed the study group. These samples were cut prospectively at 4 levels. The control group consisted of 277 skin specimens meeting the same criteria from our 2005 study which were cut at a single level. We compared the turnaround time for the two groups. We also performed a cost analysis comparing this targeted method with prospectively cutting deeper levels on all skin specimens.
Results: In the study group, 13/199 (6.5%) cases required additional levels. The same group of specimens in our prior study in which a single level was performed had a significantly higher requirement for deeper levels, 167/277 (60%) (p<0.0001). The turnaround time between the study cases and controls was also significantly different (mean =1.31 days vs. 2.83 days, respectively, p<0.0001). Accounting for the initial production of slides and the cutting of additional levels, the projected cost of performing prospective deeper levels on skin specimens measuring <=0.5 cm or punch biopsies is $2.18 less per case than performing prospective deeper levels on all skin specimens. For our hospital, with an average of 20,000 skin specimens a year, this amounts to saving $33,689 per year, or approximately one half of a full time employee equivalent (histotechnologist). Additionally, the projected number of slides for one year cutting selective levels on all specimens is 77,051 vs. 114,077 with prospective levels, resulting in decreased storage requirements.
Conclusions: Cutting prospective deeper levels on skin specimens which measure <=0.5 cm and punch biopsies significantly reduces the need for additional levels and greatly improves turnaround time. Targeting this select group of specimens for prospective deeper levels is more cost effective than performing deeper levels on all skin specimens and reduces storage requirements.
Category: Quality Assurance

Tuesday, March 10, 2009 8:45 AM

Platform Session: Section F 1, Tuesday Morning