CRITICAL VALUES FOR PROFESSIONAL STAFFING IN ANATOMIC PATHOLOGY

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Johnathan Hensley
6 years ago
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1 CRITICAL VALUES FOR PROFESSIONAL STAFFING IN ANATOMIC PATHOLOGY G. Cattoretti, A. Milazzo, Unitá Operativa Complessa di Anatomia Patologica, Citologia Diagnostica e Genetica Medica (Dipartimento di Patologia Clinica) e Universitá degli Studi di Milano-Bicocca Dipartimento di Scienze Chirurgiche PD-14 INTRODUCTION: Professional staffing requirements in Histopathology is a controversial, ill-documented but badly needed standard. Furthermore, strain on the service caused by temporary or long lasting reduction of the staff is scarcely reported and almost never methodically analyzed, also because there are no standards or methods to measure such strain. We analyze the workflow in our Department of Histopathology over 2 years ( ), by data mining from the histopathology laboratory information system (LIS) database and paper logs, including repeated occasions in which we experienced staff reduction.

2 STAFF AND WORKLOAD FOR THE DEPT. OF PATHOLOGY OF HSG

3 WORKFLOW AND TASKS FOR THE DEPT. OF PATHOLOGY OF HSG * one or more technician from these sub-sections may be moved to sections 5 and 7 (embedding and cutting), if needed. ** one pathologist on rotation for cytology sign-out.

4 Pathology services provided by the Pathology Department of HSG 45,000 40,000 35,000 30,000 25,000 20,000 15,000 10,000 Citologia PAP tests Istologia Istologia (no HB) 5, Proj 2009

5 TIMELINE OF WORKFLOW VARIABLES Blocks / week Processing delay (days) Techs cutting / day Blocks / tech / week Blocks cut / week Blocks embedded / week IHC and special sections A: Number of blocks generated weekly and blocks cut per technician per week; scale on the left. Days of delay of processing, mean number of technicians cuttings blocks daily; scale on the right. B: number of blocks generated per week, number of blocks cut per week, number of blocks re-cut weekly for immunostains and special stains. Vertical grey shaded bars highlight technical turnaroud time (TAT) increases (A) corresponding to negative balance of cuttting minus embedding (B) and shortage of staff (A).

TIMELINE OF WORKFLOW VARIABLES Trays / week Pathologists at sign-out / week Trays per pathologist / week Number of complete, finished trays per week given to pathologists; scale on the left.

6 TIMELINE OF WORKFLOW VARIABLES Trays / week Pathologists at sign-out / week Trays per pathologist / week Number of complete, finished trays per week given to pathologists; scale on the left. Number of pathologists signin out per week, weekly amount of trays per pathologist; scale on the right. Vertical grey shaded bars highlight technical turnaroud time (TAT) increases corresponding to negative balance of cuttting minus embedding and shortage of technical staff.

7 CRITICAL VALUES FOR THE TECHNICAL PART OF HISTOPATHOLOGY Correlation between the differential of blocks cut minus the number of blocks embedded and A: the number of technicians available for sectioning, B: the number of blocks received. C: Correlation between the number of block cut per week by each technician and the number of blocks processed weekly. Each circle represents the value for one week. Grey vertical bars represents threshold values for efficient processing.

8 RESULTS: Our data show that 13 full time pathology technicians or more are required to handle not more than 1700 blocks per week for a total of approximately 25,000 specimens/year; a minimum of 5 technicians per day must do block sectioning. Unexpected reduction of professional technical staff, resulting in diagnostic delays due to overload of the productive capacity, must be matched upfront by enough technical staffing to resume regular case output in the shortest time possible. The workload for pathologists was analyzed by tallying the daily workload in trays, the SIAPEC Unit weight of the cases assigned and the total time on duty, including overtime. 10 minutes for each specimen Unit is a minimum load for experienced pathologists in a community Hospital, barely if adequate for a Teaching Hospital

Internal Quality Assurance Framework Anatomical Pathology

Internal Quality Assurance Framework Anatomical Pathology The Royal College of Pathologists of Australasia received funding from the Department of Health, under the Quality Use of Pathology Program (QUPP)