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Gaurav Sharma, Bryan J Dangott , Anthony Piccoli

Reduction In Slide Label Mis -Identifications Due To Implementation Of 2 Dimensional Bar Coding In The Anatomic Pathology Laboratory At A Tertiary Care Hospital Session 3, St. George Pathology Informatics 2010 September 20, 2010. Gaurav Sharma, Bryan J Dangott , Anthony Piccoli

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Gaurav Sharma, Bryan J Dangott , Anthony Piccoli

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  1. Reduction In Slide Label Mis-Identifications Due To Implementation Of 2 Dimensional Bar Coding In The Anatomic Pathology Laboratory At A Tertiary Care HospitalSession 3, St. GeorgePathology Informatics 2010September 20, 2010 Gaurav Sharma, Bryan J Dangott, Anthony Piccoli Luke T Wiehagen, Susan M Kelly, William R Stewart Samuel A Yousem, LironPantanowitz, Anil V Parwani. Department of Pathology University of Pittsburgh Medical Center Pittsburgh, Pennsylvania, United States Email: sharmag@upmc.edu

  2. Background • Barcoding in AP labs • Identification • Workflow • Tracking • UPMC histology bar-coding project has evolved from Pittsburgh Regional Healthcare Initiative (PRHI) • PRHI Executive Summary (August 2004) : Moving towards one-by-one processing at UPMC Shadyside “Because the team would be using techniques adopted from the Toyota Production System (TPS), and because histology, the midpoint of the work, operated something like an assembly line, the decision was made to begin there. Eventually, the goal is to make the entire process—from the Gross Room to the pathologist’s interpretation—one continuous flow process.”

  3. Workflow-PreBarcodingImplementation Gross Room Received Accessioned Container Requisition Hand Labeled Cassettes Hand Labeled Grossed & Cassettes Submitted Coverslip Verify Slide Labels Printed Blocks processed Slide(s) made Tissue Embedded Cassettes Verified Histology Slides sent to Pathologist Manual entry or retrieval of case #

  4. Workflow-Post BarcodingImplementation Gross Room Received Accessioned Container Barcode Case details Entered Grossed & Cassettes (Barcode) Stained Cover-slip Verified Slide Labels Printed Blocks processed Slide(s) made Tissue Embedded Cassettes Verified Histology Slides sent to Pathologist

  5. Technology • Laboratory information system-CoPath version 3.2 with workflow and tracking system-CoPath Plus Advanced Barcoding and Tracking (Cerner DHT, Kansas City, MO) • Barcode cassette printers-Shandon Microwriter (Thermo Scientific, Waltham, MA) and GDKV2-C (General Data Corporation, Cincinnati, OH) • Thermal slide label printers-Cognitive Cxi (CognitiveTPG, Lincolnshire, IL) using chemical resistant adhesive labels -StainerShield XT(General Data Corporation, Cincinnati) • Barcode scanners-Symbol DS 6607 and 6707 (Motorola Corporation, Schaumburg, IL).

  6. Design • 2 D Datamatrix • Vendor: General Data • Blocks • Slides • Barcode scanners: • Accessioning area • Gross Room • Histology Room • Pathologist Offices • Barcode printers (cassettes): Gross Room • Barcode printers (slides) : Histology Room

  7. *Order secondary stains or annotate blocks* Cassette Engraver *VERIFY blocks post-embedding* Processor *Track blocks pre/ post-processing* Embedding *PRINT labels or queue slide engraving* Microtomy Cassette File Label printer

  8. Label printer *Stain code id’ed by stain processor* Staining *VERIFY slides prior to distribution* Final distribution *OPEN specimen or validate against bar-coded report *ORDER recuts/stains Case review & Sign out Slide File

  9. Results

  10. Defects • Causes • Pre-barcode • Manual entry of case numbers • Post-barcode • Tissue curl (from preceding case) picked up • Cytology blocks not barcoded • Resolution (recent cases) • Recently, issues are not related to manual case entry • Personnel issues, not related to barcode technology • Cytology blocks to be barcoded

  11. Results As a technology • Complex • Multi-step process integration • Factor in LIS updates and compatibility • Novel tracking solutions had to be designed • Implementation • Must be well planned with input from vendors • Adequate resource and time must be committed • Equipment procurement/installation takes time • Downtime procedures must be written up

  12. Conclusions • Anatomic pathology specimen identification systems such as 2D barcodingand associated tracking tools can help significantly reduce mislabeling errors in the pathology laboratory and thus improve patient safety.

  13. Other benefits • Real time status tracking • Containers, blocks, slides etc. • Case can be tracked with better accuracy • A tracking tool (Advanced Barcode & Tracking) was co- developed with the vendor • Digital Pathology workflow • Barcode protocols can be extended to images for definite image and specimen identification

  14. http://www.neatorama.com/images/2005-11/zebra-barcode.jpg

  15. Thank you

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