Tzu Chi Medical Journal
Volume 21, Issue 2 , Pages 140-146, June 2009

Computer-aided Monitoring of Surgical Pathology Workflow

  • Chih-En Tseng

      Affiliations

    • Department of Anatomic Pathology, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
    • School of Medicine, Tzu Chi University, Hualien, Taiwan
    • ,
  • Chin-Lon Lin

      Affiliations

    • School of Medicine, Tzu Chi University, Hualien, Taiwan
    • Department of Cardiology, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
    • ,
  • Shi-Shie Huang

      Affiliations

    • Department of Information Services, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
    • ,
  • Kuan-Chung Lin

      Affiliations

    • Department of Information Services, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
    • ,
  • Shu-Mei Chang

      Affiliations

    • Department of Anatomic Pathology, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
    • ,
  • Sou-Hsin Chien

      Affiliations

    • School of Medicine, Tzu Chi University, Hualien, Taiwan
    • Department of Plastic Surgery, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
    • Corresponding Author InformationCorresponding author. Department of Plastic Surgery, Buddhist Dalin Tzu Chi General Hospital, 2, Min-Sheng Road, Dalin, Chiayi, Taiwan

Received 6 October 2008; received in revised form 5 November 2008; accepted 9 December 2008.

Article Outline

Abstract 

Objective

To explore the feasibility of computer-aided monitoring of surgical pathology workflow.

Materials and Methods

We analyzed the four subprocesses in the surgical pathologic process: (1) arranging surgical pathology examination to receipt of the examination sheet and sample by the laboratory; (2) receipt of the sample to issuance of the pathology report; (3) issuance of the pathology report to automatic forwarding of positive pathology reports by e-mail to the physician; (4) receipt of the positive report to physician response acknowledging receipt.

Results

About 99.2% of the 20,287 samples arrived at the surgical pathology laboratory within 1 work day after the examination was ordered. The pathological report was finished within 1, 2, 3, and 4 work days in 48.7%, 86.4%, 95.8%, and 98.1% of cases, respectively, and was overdue (over 4 working days) in 1.9% of cases. The two main reasons for overdue reports were decalcification of bone samples (41.7%) and complex processing of samples (37.1%). There were 2239 (11%) positive pathological reports that required automatic computer forwarding; the highest percentage (84.3%) of these was reports of malignancies. Automatic computer forwarding succeeded in 99.6% of cases. Physicians replied to confirm receipt of positive reports within 24 and 120 hours after receipt in 52.4% and 83.6% of cases, respectively.

Conclusion

The use of the computer to monitor surgical pathology work-flow is feasible. This method can be used for quality assurance in surgical pathology workflow.

Keywords:  Computer-aided monitor , Quality assurance , Surgical pathology , Workflow

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References 

  1. Nakhleh RE . What is quality in surgical pathology? . J Clin Pathol . 2006;59:669–672
  2. Makary MA , Epstein J , Pronovost PJ , Millman EA , Hartmann EC , Freischlag JA . Surgical specimen identification errors: a new measure of quality in surgical care . Surgery . 2007;141:450–455
  3. Nakhleh RE , Zarbo RJ . Surgical pathology specimen identification and accessioning: a College of American Pathologists Q-Probes Study of 1,004,115 cases from 417 institutions . Arch Pathol Lab Med . 1996;120:227–233
  4. Start RD , Cross SS , Smith JH . Assessment of specimen fixation in a surgical pathology service . J Clin Pathol . 1992;45:546–547
  5. Gephardt GN , Zarbo RJ . Interinstitutional comparison of frozen section consultations. A College of American Pathologists Q-Probes study of 90,538 cases in 461 institutions . Arch Pathol Lab Med . 1996;120:804–809
  6. Kronz JD , Westra WH , Epstein JI . Mandatory second opinion surgical pathology at a large referral hospital . Cancer . 1999;86:2426–2435
  7. Renshaw AA , Gould EW . Measuring the value of review of pathology material by a second pathologist . Am J Clin Pathol . 2006;125:737–739
  8. Weydert JA , De Young BR , Cohen MB . A preliminary diagnosis service provides prospective blinded dual-review of all general surgical pathology cases in an academic practice . Am J Surg Pathol . 2005;29:801–805
  9. White VA , Trotter MJ . Intraoperative consultation/final diagnosis correlation: relationship to tissue type and pathologic process . Arch Pathol Lab Med . 2008;132:29–36
  10. Grzybicki DM , Turcsanyi B , Becich MJ , Gupta D , Gilbertson JR , Raab SS . Database construction for improving patient safety by examining pathology errors . Am J Clin Pathol . 2005;124:500–509
  11. Grzybicki DM , Raab SS , Janosky JE , et al.   Anatomic pathology and patient safety: it's not an error: it's a diagnostic misadventure! . Am J Clin Pathol . 2008;129:167–168
  12. Longo DR , Hewett JE , Ge B , Schubert S . The long road to patient safety: a status report on patient safety systems . JAMA . 2005;294:2858–2865
  13. Kazzi JC , Lloyd PJ , Bryant S . Turnaround times for reports on uncomplicated biopsies in five major anatomical pathology laboratories in NSW, Australia . Pathology . 1999;31:406–412
  14. Novis DA , Zarbo RJ , Saladino AJ . Interinstitutional comparison of surgical biopsy diagnosis turnaround time: a College of American Pathologists Q-Probes study of 5384 surgical biopsies in 157 small hospitals . Arch Pathol Lab Med . 1998;122:951–956
  15. Ribé A , Ribalta T , Lledó R , Torras G , Asenjo MA , Cardesa A . Evaluation of turnaround times as a component of quality assurance in surgical pathology . Int J Qual Health Care . 1998;10:241–245
  16. Zarbo RJ , Gephardt GN , Howanitz PJ . Intralaboratory time-liness of surgical pathology reports. Results of two College of American Pathologists Q-Probes studies of biopsies and complex specimens . Arch Pathol Lab Med . 1996;120:234–244
  17. Vollmer RT . Analysis of turnaround times in pathology: an approach using failure time analysis . Am J Clin Pathol . 2006;126:215–220
  18. Zarbo RJ . Determining customer satisfaction in anatomic pathology . Arch Pathol Lab Med . 2006;130:645–649

PII: S1016-3190(09)60026-4

doi:10.1016/S1016-3190(09)60026-4

Tzu Chi Medical Journal
Volume 21, Issue 2 , Pages 140-146, June 2009

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