Gaurav Sharma, Bryan J Dangott, Anthony Piccoli Luke T Wiehagen, Susan M Kelly, William R Stewart Samuel A Yousem, Liron Pantanowitz, Anil V Parwani. Department of Pathology University of Pittsburgh Medical Center Pittsburgh, Pennsylvania, United States

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.”

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

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

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).

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

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

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

Results Pre-implementation (2.5/m)Implementation (0.5 cases/m) Post-implementation (0.58 cases/m)

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

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

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

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

Thank you