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Reengineered Workﬂow in the Anatomic Pathology Laboratory Costs and Beneﬁts Erin E. Grimm, MD; Rodney A. Schmidt, MD T echnology and workﬂow in the anatomic pathology (AP) laboratory have been relatively static during the last few decades, even though the volume of cases pro- clude mistakes in patient identiﬁcation and mistakes in designation of tissue site. This study found that the prean- alytic error rate for surgical specimens was 4.3 per 1000 cessed and the complexity of cases have increased. In oth- at a major US academic hospital. The College of American er industries, static processes in a changing environment Pathologists2 has also addressed the question of error rates cause businesses to lose their competitive edge. Robust through a Q-probes survey that asked laboratories, most business models adapt to changing environments and take of which were located in the United States, to report the advantage of new tools. With tightening budgets through- number of corrected surgical pathology reports during a out health care, the AP Department at University of Wash- designated period. Laboratories reported an average of 2 ington (UW) in Seattle has critically evaluated workﬂow amendments per 1000 surgical reports. Twenty percent of in the AP laboratory and reengineered workﬂow using bar these amendments were due to patient identiﬁcation er- code technology and tailored software applications. The rors. result has been improved efﬁciency that has created cost The 2 studies are snapshots of errors occurring at par- savings while improving patient safety. This presentation ticular steps, but these studies do not accurately reﬂect highlights common workﬂow problems experienced by total error. They do not capture errors corrected before AP laboratories and describes how UW has used hard- signout. Neither do they retrospectively review randomly ware and software to automate as many manual processes selected cases for accuracy. No study has addressed total as possible. Lastly, we discuss questions for the future of error rates. laboratory automation in AP. Roger Resar,3 a leader in the ﬁeld of quality improve- One of the ﬂaws in current laboratory workﬂow is that ment methodologies, related average error rates to the the basic processes of most laboratories were designed methodology used by the system. With systems based on during a time when laboratories processed fewer cases per humans following a deﬁned protocol, errors occur at rates day. With increasing volume, small inefﬁciencies in the of a few per 100. An example is a protocol used in an workﬂow are magniﬁed. Most laboratories are not maxi- emergency department for treatment of community-ac- mizing use of their resources, especially their most valu- quired pneumonia, in which the protocol is available for able resource, labor. use but is not required and no checks are in place to see The second problem relates to patient safety. Medical that the protocol is used correctly. A more intensive meth- errors occur in the pathology department, just as they do od is a protocol with error mitigation techniques. With this in all areas of medicine. Most laboratories rely on the vig- method, an error rate of a few per 1000 is achievable. ilance of pathologists and staff to catch these errors. How Transfusion medicine commonly uses such methods. Pro- well does vigilance work? One study by Makary1 quanti- cedures require that the patient’s blood type, as deter- ﬁed preanalytic errors (errors occurring before the speci- mined by laboratory testing, is later checked against his- men reaches the laboratory). Examples of such errors in- torical patient blood type records to make sure the blood types match. The methods we have discussed so far Accepted for publication October 1, 2008. achieve an error rate of a few per 1000. From the University of Washington Medical Center, Seattle (Dr In the AP laboratory, what
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