Use of 2D Bar Code Technology and Single Piece Throughput in the Reduction of Specimen Labeling Errors
Robin E Weisburger, Shannon N Schutz, Peter P Seery, Donald E Ulinski. Dartmouth-Hitchcock Medical Center, Lebanon, NH
Background: Specimen labeling errors are an inherent risk in Anatomic Pathology. A 2009 CAP Q-Probe Study which focused on labeling errors in Surgical Pathology found a median rate for mislabeled blocks of 1.0 per 1000 and mislabeled slides of 1.2 per 1000. In 2011, Dartmouth-Hitchcock's Anatomic Pathology and Histology laboratories began a 2D barcoding initiative with a goal of reducing slide and block labeling errors by 50%.
Design: This initiative is designed to implement 2D barcoding throughout Anatomic Pathology and Histology. 2D barcodes on specimen labels, tissue cassettes and slides contain patient, specimen, and tissue section specific information. Specimen labels, cassettes and slides are printed on demand to support single piece flow throughout the system. Custom programming in the Cerner Millennium Laboratory Information System (LIS) performed by the Laboratory's IT Specialist enables the print devices to access specific case and block information.
Tissue cassettes are printed on Thermo-Scientific Microwriters at the time of specimen setup. Technicians are instructed to work on one case at a time, and each cassette has a corresponding 2D barcode linking it to the LIS with case and block identification data.
Each histotech is provided with a slide writer, the Thermo-Scientific Slidemate. The histotech scans the block which interfaces with the LIS. The slide writer prints all slides based on requests pending for that block. The slides are verified in the LIS when completed, and subsequent requests can be entered and printed for recuts and special stains.
Results: During the baseline period (March - May, 2011), the laboratory averaged 2.5 mislabeled blocks per 1000 and 0.086 mislabeled slides per 1000. The data for the implementation month (June) were not counted as several process adjustments were required during that time. During the three months post implementation (July - August), the laboratory averaged 0.7 mislabeled blocks per 1000 and 0.017 mislabeled slides per 1000 resulting in a 73% and 80% improvement, respectively.
Conclusions: The utilization of barcode technology coupled with single piece throughput offers a safer system in terms of maintaining the integrity of specimen labeling throughout the system. Mislabeling events still occur. Data collection in Surgical Pathology is now enhanced to identify where in the process errors occur, i.e. during setup of specimens, reprinting of cassettes, or gross dissection of specimens. Additional process redesign is planned to address these errors when the areas of greatest risk are identified.
Category: Quality Assurance
Monday, March 19, 2012 1:00 PM
Poster Session II # 249, Monday Afternoon