Quality Improvement in Pathology through Real-Time Labeling
Robert Stapp, Mehrvash Haghighi, Ron Brown, Michael Czechowski, Beverly Mahar, Richard Zarbo, Mark Tuthill. Henry Ford Hospital, Detroit, MI
Background: We implemented a 'real-time labeling' process in the anatomic pathology department. 'Real-time labeling' is a process enabled through our laboratory information system (LIS) which allows case-by-case labeling of anatomic pathology cassettes and slides with reductions in patient specimen misidentification rates and improved efficacy in daily workflow. This process is the extension of several other cycles of improvement, encompassing five years of effort.
Design: Prior to this process, tissue cassettes were printed with case identification details using cassette printers, which required re-entering demographic and case data into dedicated software. After processing, slides were manually labeled and stained. Paper labels were batch printed and affixed onto slides. This manual process was replaced by a “bar code specified surgical pathology” workflow that automated labeling of slides and cassettes, replacing paper labels with stain resistant labels. We have continually evaluated this process by applying the plan, do, check, act (PDCA) methodology. Recently, we replaced linear bar codes with 2D bar codes as part of an upgrade of our LIS, which also included replacement of the old labeling system with 'real-time labeling'. The new functionality allowed seamless slide label printing in real-time as each histology block was scanned before sectioning. 2D barcode scanners were installed at individual workstations within grossing rooms, pathologists' offices, and histology lab.
Results: Previously, the process of batch printing labels increased the risk of patient misidentification. While this was addressed with prior PDCA cycles, it was prone to failure in label production from cassettes and slide bar code read errors. Since, bar codes were unreliable, their use in managing cases decreased. With 'real-time labeling' the batch printing process been eliminated and misidentification rates have been further reduced from 0.62% to 0.02%. Histology efficacy has increased as cassette reading defects have been eliminated, that required manual entry of case numbers. Since implementation, we have seen no internal patient identification issues due to labeling. Finally, the linear label barcode defects have been entirely eliminated by using 2D barcodes on slide labels. This has decreased read errors from 20% of slides on a daily basis to 0%.
Conclusions: Through the use of multiple PDCA cycles we were able to improve processes throughout laboratory with the implementation of 'real-time labeling'. The changes have led to reductions in patient misidentification, increased efficiency, and improved turn-around time.
Category: Quality Assurance
Monday, March 4, 2013 1:30 PM
Proffered Papers: Section G, Monday Afternoon