Methods to Improve Sustainability of a Large Academic Biorepository.

This article discusses the evolution of the University of Pittsburgh (UPitt) Health Sciences Tissue Bank (HSTB) operation and how it has successfully positioned itself, manages to sustain its value, and remains viable in today's research landscape. We describe the various components of our biobanking operation, which are valued by our researchers, thus leading to sustainability for our biorepository. Operating within the infrastructure of a large academic university, we have access to the most cutting-edge database resources for collecting, tracking, and annotating thousands of specimens. We are constantly improving upon our ability to provide real-time longitudinal follow-up data for our collections, thus providing researchers with valuable, highly annotated research specimens. We believe the combination of all that is described within this article helps to create a biobank that will remain sustainable well into the future.

Tissue adequacy for ancillary studies beyond frozen section: a potential method for improving diagnostic and therapeutic results.

The evolving nature of medicine has created new challenges in numerous aspects of the practice of pathology. The development of less invasive procedures, the generation of better diagnostic tools, and the recognition of prognostic markers have contributed to these challenges. Between 42.7% and 65.0% of intraoperative consultations are performed to identify or type a neoplastic process. We instituted a reporting requirement on our intraoperative consultations to provide an assessment of adequacy. The assessment of adequacy was subjective by its very nature and was based on the possible uses for the submitted tissue. A total of 3086 intraoperative consultations were performed over a 13-month period. Sixty-two cases were determined to be insufficient for ancillary studies; 52 of these cases were remedied by the surgeon during the original diagnostic procedure. We have instituted a new assessment for intraoperative consultations to optimize the tissue obtained and reduce the need for additional procedures.

Numerical fidelity of endoscopic biopsy fragments in the processing sequence of a university surgical pathology laboratory.

CONTEXT: Diagnostic specimens in surgical pathology are, in general, becoming smaller and smaller, as minimally invasive surgical procedures are used to obtain representative tissue. Conservation and effective utilization of small biopsy tissue is therefore crucial in the pathology laboratory. OBJECTIVE: To identify potential areas where biopsy tissue may be lost in the course of processing in our university-based laboratory. DESIGN: We followed 2934 endoscopic biopsy samples as they moved through our grossing area and histology laboratory by documenting the number of fragments inked and placed within tissue paper at the time of gross assessment, the number of fragments found in each cassette after processing and subsequently embedded in paraffin, and the number of pieces of tissue present on glass slides after staining. RESULTS: In 805 (27.4%) cases, the number of fragments of tissue noted on glass slides containing 2 levels of the paraffin block differed from the number submitted in the tissue cassette. Of these, most (137, 17%) differed between the number of fragments embedded in paraffin and those identified on glass slides. Loss of tissue fragments occurred in only 7.2% of cases, while 26.3% had gains in tissue fragments. CONCLUSIONS: Recognition of type(s) and source(s) of variation in biopsy fragment numbers is important in quality control and in the overall practical management of a histology laboratory.

Use of a laboratory information system driven tool for pre-signout quality assurance of random cytopathology reports.

BACKGROUND: Quality assurance (QA) programs in cytopathology laboratories in the USA currently primarily involve the review of Pap tests per clinical laboratory improvement amendments of 1988 federal regulations. A pre-signout quality assurance tool (PQAT) at our institution allows the laboratory information system (LIS) to also automatically and randomly select an adjustable percentage of non-gynecological cytopathology cases for review before release of the final report. The aim of this study was to review our experience and the effectiveness of this novel PQAT tool in cytology. MATERIALS AND METHODS: Software modifications in the existing LIS application (CoPathPlus, Cerner) allow for the random QA of 8% of cases prior to signout. Selected cases are assigned to a second QA cytopathologist for review and all agreement and disagreements tracked. Detected errors are rectified before the case is signed out. Data from cases selected for PQAT over an 18-month period were collected and analyzed. RESULTS: The total number of non-gynecological cases selected for QA review was 1339 (7.45%) out of 17,967 cases signed out during this time period. Most (1304) cases (97.4%) had an agreement in diagnosis. In 2.6% of cases, there were disagreements, including 34 minor and only 1 major disagreement. Average turnaround time of cases selected for review was not significantly altered. CONCLUSION: The PQAT provides a prospective QA mechanism in non-gynecological cytopathology to prevent diagnostic errors from occurring. This LIS-driven tool allows for peer review and corrective action to be taken prior to reporting without delaying turnaround time, thereby improving patient safety.

Initial experience with a novel pre-sign-out quality assurance tool for review of random surgical pathology diagnoses in a subspecialty-based university practice.

We recently implemented a novel pre-sign-out quality assurance tool in our subspecialty-based surgical pathology practice at the University of Pittsburgh Medical Center. It randomly selects an adjustable percentage of cases for review by a second pathologist at the time the originating pathologist's electronic signature is entered and requires that the review be completed within 24 hours, before release of the final report. The tool replaced a retrospective audit system and it has been in successful use since January 2009. We report our initial experience for the first 14 months of its service. During this time, the disagreement numbers and levels were similar to those identified using the retrospective system, case turnaround time was not significantly affected, and the number of case amendments generated decreased. The tool is a useful quality assurance instrument and its prospective nature allows for the potential prevention of some serious errors.

The development and testing of a laboratory information system-driven tool for pre-sign-out quality assurance of random surgical pathology reports.

We describe the development and testing of a novel pre-sign-out quality assurance tool for case diagnoses that allows for the random review of a percentage of cases by a second pathologist before case verification and release of the final report. The tool incorporates the ability to record and report levels of diagnostic disagreement, reviewers' comments, and steps taken to resolve any discrepancies identified. It is expandable to allow for the review of any percentage of cases in any number of subspecialty or general pathology "benches" and provides a prospective instrument for preventing some serious errors from occurring, thereby potentially affecting patient care in addition to identifying and documenting more general process issues. It can also be used to augment other more conventional methods of quality control such as frozen section/final diagnosis correlation, conference review, and case review before interdisciplinary clinicopathologic sessions. There has been no significant delay in case turnaround time since implementation. Further assessment of the tool's function after full departmental application is underway.