I have been promoting the idea of integrated diagnostics in this blog (see: Revisiting Integrated Diagnostics and the Integrated Diagnostic Report) and suggested that the goal of no more than a three-day turnaround time for breast cases would be a suitable goal. In a recent note, I presented evidence that the current diagnostic-delay-time (DDT) for breast lesions from the time of initial screening until a definitive diagnosis is about 16 to 60 days (see: Diagnostic Delay Time (DDT) and Integrated Diagnostics). The Dark Daily recently ran a story about the University of Nebraska-Omaha and the technology they were deploying in surgical pathology. The lab is generating reports for a significant number of patients on a same-day basis. (see: Lean and New Diagnostic Technologies Fuel Innovations at the Pathology Department at University of Nebraska-Omaha). Below is an excerpt from the article:
Tour guide and laboratory manager David Muirfield explained that the anatomic pathology department is now capable of reporting a significant number of cases on a same-day basis. The ongoing quality improvement program is delivering continual improvements in turnaround time and quality. The increased productivity also produces worthwhile cost savings. UNMC’s histology laboratory is well-equipped with the latest generation automated systems. A best-of-breed preference can be seen. Systems from such histology vendors as Dako, Milestone Medical, Sakura Finetek, and Ventana Medical Systems all are in daily use in the histology laboratory. As a beta site, UNMC’s histology laboratory is also evaluating next-generation products currently undergoing FDA review. This gives its pathologists and technical team an early look at next-generation histology technology. Another new technology initiative at UNMC’s Department of Pathology is digital pathology systems. To this end, the pathology department has acquired multiple digital pathology systems from BioImagene. This equipment is being installed and validated. Pathologists expect to initially use digital pathology images for teaching and for handling referral cases. Looking forward, the pathologists at UNMC point out that digital pathology will allow them to provide sub-specialist pathology support to rural hospitals in Nebraska, which has many thinly-populated agricultural counties.
I am sure that most readers of this blog well understand that the deployment of new technology alone is usually insufficient to realize a shorter turn-around-time in histopathology. It will also certainly be necessary to scrutinize and optimize workflow to accomplish this goal. The Lean methodology may be an enabling tool for this process (see: Histology Technology and Lean Healthcare Hand in Hand). Below is an excerpt from an on-point article about Lean in one lab:
Virtua [Voorhees Histology Lab in New Jersey] wanted to take advantage of technological advances and purchased a new machine for the histology lab in order to provide same-day biopsy results and, in turn, better patient care. After the new microwave processor had been installed and the staff trained, the lab did not see the drastic reduction in turnaround time that management had expected. The machine was processing fast, but the workflow bottlenecks that had been present prior to the microwave installation had not been addressed. The process steps surrounding the microwave continued to operate on a 12-hour cycle. The histology staff struggled with the lack of progress and found that process changes were difficult to implement given the current lab layout and uneven processing times for each step. Virtua leaders decided to use Lean to address the problem. Plenty of opportunity existed. The expected turnaround time was being exceeded by almost five hours. Lean leaders set goals to reduce biopsy cycle time, reduce machine idle time, and reduce non-value-added tissue wait time.