The Bowel Screening Pilot: a pathologist’s perspective Dr Nicole Kramer Anatomic pathologist LabPlus, Auckland City Hospital

Outline and approach Workload experience at LabPlus Expected workforce required Successes and stumbling blocks Specimen services Anatomic pathology (tissue retrieved at colonoscopy) Anatomic pathology (tissue retrieved at colonoscopy) Biochemistry (iFOBT) Biochemistry (iFOBT)  Workload is for the Waitemata DHB population of 575,000  Additional laboratory workload not accounted for includes testing of patients as inpatients (haematology, biochemistry, microbiology), additional histology specimens and cytogenetics

Specimen services All specimens are unpacked, checked (labelling, appropriate request form), scanned and registered with a unique laboratory identifier Receive 39,000 iFOBT per annum Receive 1462 histo cases/year (currently signed straight through) Assuming an average of 7 minutes/case  4450 hours/year 87.5 hrs/week 10% loading for leave (holiday etc.)  2.4 FTE

Chemical Pathology iFOBT specimens/year Analytical time: 2 minutes/case  1300 hrs/year 25 hrs/week + 10% loading for leave  27.5hrs/week (scientist) = 0.7 FTE Chemical pathologist or senior clinical scientist required for oversight and governance for troubleshooting and quality assurance (time not included)

Anatomic pathology (AP) workload – administration and clerical work Workload is variable Accounting for highest potential workload 10 minutes/case 5.6hrs/week Resections.25hrs/cancer 0.4hr/week  0.17 FTE

Anatomic pathology workload – scientist/histotechnician Registration Grossing/transfers Embedding Cutting sections Quality control Data collection and submission 0.7 FTE technical staff Immunoperoxidase fee106 2 X Level Fee12 LVL Level fee5664 No Charge fee recut fee1 rrw recut fee2 special stain fee11 Billing data for 2014 Buesa RJ. Productivity standards for histology laboratories. Annals of Diagnostic Pathology 2014 (2010);

AP workload – pathologist: screening

Average Pots per Case

AP workload – pathologist resections 224 cancers in three years 1.5 cases/week 1.75 hrs of pathologist time/case 2.6 hr/week  0.6 to 0.7 FTE total

Standards and Quality Indicators  in order to be able to be audited we may need to have some additional quality indicators for AP. For example we need to have strong support from the laboratory information system.  Reporting and audit of a number of anatomic pathology quality indicators is desirable Extraction of data from reports is hampered by the lack of laboratory information systems support available and the method by which the reports are generated Most recently data has been extracted ‘manually’ as part of an audit process

Summary  Expected FTEs for the current population screened at WDHB are estimated at:  Specimen services – 2.4 FTE  Chemical pathology – 0.7 FTE with oversight  Anatomic pathology  Administration – 0.2 FTE  Scientist/technicians – 0.7 FTE  Pathologists – FTE  Workload is variable and recruitment of an appropriate staff mix is required