For the purposes of this study, we examine the impact of a specimen tracking system in time saved per case. All steps of the histology process that involve manual labeling (except affixing a label to a specimen container at accessioning or slide at microtomy) have been eliminated and are now automated.
In the accessioning area, in some cases, the process has changed remarkably, as CPA/Norton has standardized the Laboratory Information System (LIS) across all of its facilities.
The result of this change has been to have a single process of accessioning specimens with analogous data from facility to facility. In the initial assessment, only the process using the now current LIS was observed as the other processes were scheduled to be discontinued. Previously, all specimens were manually assigned accession numbers and grossing occurred simultaneously to or even prior to the accessioning process. In addition, case numbers were manually written on specimen containers and cassettes were printed by manually typing in the case number into the printer (approximately 17 seconds/case). Following the implementation of specimen tracking, cases are now accessioned into the LIS where a case number is generated and specimen labels and cassettes are automatically printed, resulting in the elimination of two manual steps.
At grossing, each cassette was visually confirmed to match and then the specimen was grossed. Now, the specimen container is scanned into the STS to ensure a match and then the cassette is scanned into a “virtual bucket” that has a bar code assigned to it.
Cassettes are placed in tissue processing baskets where they stay in formalin until a courier picks them up to be delivered to the main CPA laboratory facility. To accurately capture the cassette information being transported, the courier scans the virtual bucket barcode and the location bar code to pick up cassettes and then scans the bucket and the new location bar code to deliver the cassettes to histology. This is an additional step that was not previously performed, but it was a safety capability of the STS that was sought after, as nearly all of the cassettes come to the lab via courier. Cassettes are then loaded onto the tissue processors to be processed to paraffin.
Once tissue cassettes have been processed, they are removed from the tissue processors and are taken to embedding. Cassettes are then scanned to record the step and tech in specimen tracking and are embedded according to standard practice. This was previously accomplished by embedding the block and then manually checking that block off a paper log.
From embedding, cassettes are moved to microtomy where, instead of handwriting slides and leaving their workstation to print labels out of the LIS (an extremely time-consuming process), they are scanned to produce slide labels at the bench. Each block is scanned just prior to sectioning. This single piece fl ow is necessary to avoid mislabeling slides.
From microtomy, slides are stained with routine H&E. Slides are then assembled to be distributed to pathologists. This process involves sorting slides by case number and then scanning slides into specimen tracking as distributed to the assigned pathologist.