Effectiveness and Efficiency in the Evaluation of Pathological Specimens of Limited or No Clinical Value
Terence R Finch, Heather S Currens, Stephen S Raab. Memorial University, St. John's, NL, Canada
Background: In Canada and the United States, many anatomic pathology laboratories do not process or perform gross-only examinations of specimens of limited or no clinical value. The impact on laboratory resources, time, and cost for examining these specific specimen types are theorized to be significant, although this has not been studied.
Design: We evaluated the clinical significance and the efficiency of processing and examining specimens of limited or no clinical value in our tertiary hospital-based Canadian laboratory. We considered 5 specimen types as not requiring submission or gross examination (e.g., aneurysm contents and teeth) and 8 specimen types as requiring gross examination only (e.g., hernia sacs and intervertebral discs). We measured the number of blocks submitted for each specimen type, non-pathologist workload units as a quantifier of laboratory resource utilization (each unit represented one minute of time and $2.65 Canadian), and clinical significance of pathologist final tissue diagnosis.
Results: We processed 274 specimens that generally did not require laboratory submission at a cost of $24,645 and 155 laboratory work hours. We processed 577 specimens that generally required a gross-only examination at a cost of $64,802 and 406.8 laboratory work hours, of which 99.8 hours and $15,872 was spent on block submission. Revision of specimen processing for specimens of limited or no clinical value could potentially save our institution 254.8 laboratory work hours and $40,517 per year. Of the 13 specimen types studied, processing tonsil and adenoid specimens demonstrated the most significant impact on laboratory resources with 307 blocks, 134.6 laboratory work hours, and a cost of $21,399. One incidental dysplastic nevus was found within an abdominal pannus specimen, otherwise there were no other unexpected critical diagnoses. In the tonsil group, we found 6 malignant cases, all with at least a suspicious for malignancy clinical history.
Conclusions: Our findings indicate that tissue block submission and gross examination of specimens generally considered of limited or no clinical value resulted in increased laboratory inefficiencies and costs. If clinicians provide pertinent clinical patient history, lab personnel could perform no or gross-only examination with considerable cost savings and without a sentinel event.
Category: Quality Assurance
Monday, March 19, 2012 1:00 PM
Poster Session II # 273, Monday Afternoon