Key metrics to track & optimise in histopathology testing

Dr Manimalar Naicker, Consultant Histopathologist & Statistician, MBBS, M.Path (Histopathology), M.Med.Stats highlights the key metrics that medical labs must track & optimise to improve histopathology testing quality, efficiency and productivity.

Dr. Manimalar Selvi Naicker

Dr. Manimalar Selvi Naicker

CrelioHealth for Diagnostics (formerly LiveHealth)
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Key metrics in Histopathology

Turnaround Time (TAT) is very important for Histopathology labs. We track it right from the beginning - from the time the specimen is collected to the time it reaches the lab. To control the turnaround time for histopathology operations, we try to take the specimen early. This is because if the transport to the lab is delayed, then the specimen comes delayed to the lab, delaying the following processes. The time taken for pathologists to sign out the reports is also a vital variable. So yes, we do consider time (TAT) as a necessary metric.

key-metrics-to-measure-histopathology-efficiency

Another very important metric to us is accuracy. Because, when we receive a specimen for testing at the lab, the first thing we want to make sure is that the specimen is collected in the right percentage (amount) and the request form is correctly filled. Also, the specimen and the request form is correctly labelled and mapped, and the patient identification is correct. Each of these steps contributes to accuracy which is essential in its own way.

We also track pre-analytical and analytical errors which include wrong labelling, or slightly printed wrong labels, incorrect mapping, etc.

Another metric is the quality of the stain itself. So these will be the main things that a histopathologist would track on a day-to-day basis.

There are of course financial aspects as well but as a practising pathologist, this is what I would monitor.

Those managing the finance will also track how we use the immunohistochemical stains. Because if the pathologist is ordering more stains then the overall cost gets affected and this cost gets passed on to patients. Even the financial guy should be able to see if a pathologist is ordering more stains than the normal required. But that is not usually tracked by the individual pathologist rather someone who is in charge of financial management.


How to reduce the TAT for the histopathology lab?

First, we must define where the TAT starts - when the specimen is taken or when it reaches the laboratory, usually in most cases we measure when the specimen reaches the laboratory.

Usually, specimen processing is done in batches. If a laboratory processes the blocks once a day and if the hospital sends the sample early in the morning and the sample processing is done in the afternoon and the slide will be ready by 11:00 the next morning.

It doesn't matter how early in the morning you send the samples - if you want to reduce the turnaround time for the histopathology lab you need to process the samples at least twice a day.


How to avoid histopathology errors?

The request form must be written in better handwriting. Unlike clinical chemistry, which does not require you to look at request forms before reporting, histopath requires clinicopathological correlation. You have to see what’s stated in the request form and see what is on the slide and put it together.

Mainly we have difficulty when:-

  1. They have handwritten forms.
  2. They don’t fill up the forms clearly with the pertinent data; they write something irrelevant to the case.

We need to be completely digital as far as possible. Even the specimen details should not be written manually but recorded digitally so that the number of errors is reduced to a large extent.


Is batching the best option?

You need to balance both economy and time otherwise cost for the test will become too high.

Histopath is not a test which most patients who come to the hospital will do, it is still an important test. You can't do it individually you have to batch it, which will increase the time to process.

One batch in the morning and one batch in the evening at 4 pm. any specimen which comes in will be processed and the slides will be ready by 11:00 a.m. The reports will be ready within 2 days. So the Turnaround for the lab is still 2 days which for histopath is a good enough metric.