Monitoring the Turnaround Time in the Anatomic Pathology Laboratory

  • Thesis Statement: This paper aims to provide the importance of monitoring the turnaround time in the anatomic pathology laboratory from an organizational management perspective.
  • Research Question: Why monitoring the turnaround time in the anatomic pathology laboratory is important from an organizational management perspective?

Background Information (2-3 Pages)

Turnaround time (TAT) is typically described as the amount of time it takes from the moment a test is requested until the result is provided, including the time spent in the pre-analytical, analytical, and post-analytical phases. Efforts to enhance the overall quality of the service given, such as a decrease in laboratory turnaround time, reflect a greater commitment to the requirements of patients (TAT). The availability of test results within a specific time frame promotes the patient’s happiness while also demonstrating the doctor’s efficiency. It is a significant component of a laboratory’s quality assurance program, and it has been highlighted as an important performance indicator of a laboratory’s overall performance and effectiveness (Emmanuel et al., 2020). Customer satisfaction may be described as the capacity of a product or service to meet and exceed the demands and expectations of its target market.

Quality has typically been discussed in laboratories only in technical or analytical aspects, emphasizing imprecision and inaccuracy objectives. One of the primary goals of anatomic pathology labs is to precisely predict the turnaround time for surgical specimens from the time of accessioning to the time of assembly of the case. For clinicians, service quality is more important than pricing since it encompasses the precision and correctness of the test and its accessibility, affordability, usefulness, and completion time. There is a need for a fast, trustworthy, and cost-effective solution that is also reliable. The physician may be ready to sacrifice analytical quality for a faster turnaround time if it means the report will arrive on time.

Despite this, many clinicians utilize turnaround time (TAT) to gauge the overall quality of anatomic laboratory services. Users instantly report delays in TAT, yet excellent TAT is ignored (Patel et al., 2012). Poor TAT is one of the most common causes of customer dissatisfaction with the laboratory. Laboratory staff takes a lot of time and effort to resolve customer concerns and enhance customer service levels. Despite advances in analytical equipment, transportation networks, and computerization, some laboratories have failed to improve their turnaround times (Tseng et al., 2014). Emergency departments’ response times have improved somewhat over the years (EDs). TAT is becoming an increasingly important service performance metric for laboratories due to an increased focus on testing outside of the laboratory. However, many are having difficulty fulfilling their internal targets in this regard.

Additional pressure is being applied to anatomic pathology labs to shorten turnaround times related to patient hospitalizations. It is well recognized that the kind of tissue being investigated and the type of stain orders sought for slides impact the processing time for specimens and falls, respectively (Dinsmore 2012). After doing a multivariate analysis, it was shown that the factors that substantially affected turnaround time were connected to pathologist activities such as consultation with other pathologists, diagnosis of malignancy, and the quantity of slides that needed to be examined.

Importance of the Research (1-2 Pages)

The workflow in an anatomic pathology laboratory is divided into three primary procedures for processing specimens. Preanalytical, analytical, and post-analytical phases are included in the workflow, each of which has multistep subprocesses that significantly influence patient care (Banks et al., 2017). A group of specialists from across the globe got together to develop a set of metrics that would serve as a foundation for labs throughout the world to assist them in analyzing and improving specimen management to decrease patient safety risk. Waiting time for treatment, patient satisfaction, and hospital costs are all impacted by delays in reporting. System delays in acquiring, processing, and reporting tested samples have been recorded in underdeveloped nations. This research aims to evaluate the TAT in the histology unit of our institution and compare it to previous studies (Volmar et al., 2015). This research will enable the researcher to evaluate the impacts of turnaround time to the anatomic pathology laboratory, medical practitioners, and the patients.

Literature Review (4-5 Pages)

Healthcare workers and pathologists must put in a concerted effort to ensure that diagnostic errors and patient mismanagement do not occur in the anatomical pathology laboratory. The aim is to achieve quantifiable quality improvements in specimen processing while minimizing the probability of undesirable consequences in inpatient treatment (Banks et al., 2017). Installing modern technology, such as specimen-tracking tools, barcode readers, advanced automated staining systems, or computerized organizing systems would aid in the reduction of turnaround time in the anatomy pathology lab. Modern storage equipment would also ensure specimens are in good condition to avoid corrupted data due to interfered specimens (Lou et al., 2014). There is evidence that case reviews may discover mistakes; as a result, the expert panel suggests that anatomic pathologists adopt protocols for reviewing pathology cases (Nakhleh et al., 2016). This is done to identify potential conflicts and interpretation problems to improve the overall quality of patient care.

When it comes to quality assurance in the laboratory, the turnaround time is vital to success. The disparity between developing and developed countries in TAT has been attributed to various factors, including interlaboratory constraints, poorly structured internal competition, interprofessional rivalry, inadequate infrastructures, external quality assurance programs, politics, and the economy (Emmanuel et al., 2020). According to the results of this study, the pre-analytical, analytical, and post-analytical phases accounted for 53.0 percent, 27.7 percent, and 19.3 percent, respectively, of the total time, spent in the laboratory (Emmanuel et al., 2020). Even though there is a statistically significant difference in LTAT between developed and developing nations, this study discovered that some progress had been made in the LTAT of developed countries thus far. The study also proposed that practical objectives for the histology labs be developed in terms of timeliness. This should be examined regularly to guarantee compliance with the law and the development of service quality in this area.

Several pathology labs have already gone “completely digital” for primary diagnosis using WSI technology. However, not many laboratories can switch to WSI since it is not yet economically practical (Dietz & Pantanowitz, 2019). Several new commercial systems seek to enhance the throughput of digital pathology platforms incorporating plug-in imaging algorithms that may be used to automate the laboratory workflow. The research also indicated a need to develop innovative measures to handle tasks in these anatomy pathology laboratories. This would ease the turnaround time hence increasing patient safety.

Augmented reality is becoming a common trend in AP laboratories. Research indicates that the introduction of AR technology such as Microsoft HoloLens has increased the quality and efficiency of laboratory services in anatomic pathology since its launch (Hanna et al., 2018). HoloLens is a revolutionary AR technology that can be used in pathology for both clinical and non-clinical reasons. The gadget is lightweight, pleasant to wear, and simple to operate. It also has enough computer power and high-resolution image capabilities to meet the needs of most users. Autopsy, gross and microscopic inspection, and digital pathology are all perfect applications for this instrument. Using AR in pathology for clinical and non-clinical purposes has proven promising (Hanna et al., 2018). The HoloLens presents a wide range of new possibilities for pathology, including creating virtual workstations, autopsy, and dynamic methods to modify digital spatial data to improve quality control.

Modern laboratory information systems (LISs) comprise complicated, interconnected computer programs and architecture that serve a wide range of lab information-processing requirements. A laboratory information system (LIS) performs duties throughout the patient testing process, including specimen and test order input, specimen processing and tracking, support for analysis and interpretation, and the development and dissemination of patient reports (Henricks, 2016). Aside from that, laboratory information systems (LISs) give management reports and other data necessary for running their operations and supporting continuous improvement and quality programs.

Several studies are also concerned with focusing on the future of anatomic pathology in ensuring quality and patient safety. Advances in three-dimensional printing are another technology that may further decrease the turnaround time since analyzing lab tests may be made simpler, resulting in the procedure being completed more quickly and efficiently (Mahmoud & Bennett, 2015). Three-dimensional printing technology can significantly enhance the quality of anatomic pathology specimens that are three-dimensional printable. A safe and cheap approach for manufacturing 3D physical representations of real-world things, three-dimensional (3D) printing technology is becoming more popular. Using this method, a 3D model of an item is created with accurate representations of depth, shape, and texture. A crisp, exact duplicate of the depicted would help pathologists promptly analyze and test specimens.

The importance of pathology and laboratory medicine (PALM) to a functional healthcare system is not sufficiently appreciated at the policy and governmental levels. In response to the quality assurance barrier, emerging technologies such as telepathology and point-of-care testing play a significant role in delivering PALM services, provided they are utilized effectively (Sayed et al., 2018). Research also stresses the critical necessity of sustaining PALM quality and argues that all labs in low- and middle-income countries (LMICs) should engage in quality assurance and certification programs to achieve this goal (Sayed et al., 2018). The study presented a PALM package specifically tailored to these nations to implement these solutions and guarantee equal access to key services in LMICs. It integrated it into a nationally graded laboratory system as part of an overall national laboratory strategy plan.

Organizational Plan (3 Pages)

Hospitals cannot enhance quality without assessing quality, and they cannot measure quality unless they have accurate, reliable data. Physicians and hospitals want comprehensive and precise data to offer a thorough and precise knowledge of the quality of surgical treatment compared to that delivered by comparable institutions for similar patients in the same geographic area. Collecting the appropriate data is also an essential step in improving care, and it is one of four processes in the process of continuous quality improvement. For quality improvement initiatives to be effective, hospitals and providers must be held responsible to four fundamental standards:

  1. Establish and maintain meaningful and relevant standards.
  2. Create the appropriate resource infrastructure to assist them in treating their patients.
  3. Collect a large amount of data.
  4. Submit to a verification process in which they enable their facilities, procedures, and results to be inspected by an external auditor as part of verification.

Specific areas of overlap in the improvement of quality may be divided into four categories:

  1. Quality must be defined and measured.
  2. Data quality assurance and capacity-building for data usage for decision-making and responsiveness to quality measures, including applying QI methodology, are two important goals.
  3. Increasing the effectiveness of supportive supervision and mentoring
  4. The purpose of doing operational research is to understand better the variables that contribute to observed variance in product quality.

Necessary national standards in AP pathology have been established via the Q-Probes initiative, which has addressed pre-analytical, analytical, and post-analytical aspects in the fields of surgical pathology, cytopathology, and autopsy pathology. The results of the Q-Probes research have been published, quoted, and included in the development of laboratory assessment criteria and other national recommendations, among other things (Tworek et al., 2014). Anatomic or clinical pathology laboratories may use Q-Probes to investigate a particular technique, result, or structure in-depth. In the field of anatomic pathology, only a few studies have examined the usefulness of Lean quality improvement strategies, such as education, in improving patient safety (Smith et al., 2012). Lean implementation can increase pathological patient safety via cultural change and the execution of particular work process modifications.

After developing various strategies or programs to ensure quality and efficiency, it is wise for the management board to communicate and share the information with the employees. This enables the staff to be ready for any form of change that may take place. To guarantee the success of a project, it is necessary to convey information about the project’s goals, objectives, expectations, deliverables, timetables, progress, risks, obstacles, and accomplishments frequently. Through two-way communication, one will most likely discover that the employees who work in the region are entirely aware of any modifications that may be made to enhance the quality of service. When developed via participation, empowerment, and listening, staff-generated ideas and solutions are often the most successful and long-lasting. As a result of discussions with employees, ensure that one is taken action and that the progress is communicated. Minor changes may help build momentum for a project and pique the attention of those interested in it.

Special training may also be initiated to ensure the staff is familiar with the change or the new technology. This is to avoid any errors that may be attained due to the inappropriate handling of the latest technologies. The new technology to be implemented should be put to the test to test its reliability before entirely putting it into use. This is to ensure patient safety as a result of the faultiness of the technology.


Banks, P., Brown, R., Laslowski, A., Daniels, Y., Branton, P., Carpenter, J., Zarbo, R., Forsyth, R., Liu, Y., Kohl, S., Diebold, J., Masuda, S., Plummer, T. & Dennis, E. (2017). A proposed set of metrics to reduce patient safety risk from within the anatomic pathology laboratory. Laboratory Medicine, 48(2), 195-201.

Dietz, R. L., & Pantanowitz, L. (2019). The future of anatomic pathology: Deus ex machina. Journal of Medical Artificial Intelligence, 2(4), 1-5.

Dinsmore, C. (2012). Development and Validation of a Predictive Model for Turnaround Time of Anatomic Pathology Specimens. Department of Computing and Digital Media DePaul University.

Emmanuel, I., Abaniwo, S., Nzekwe, P., Richard, S. K., Abobarin, O., Longwap, A., & Joseph, A. (2020). Laboratory turnaround time of surgical biopsies at a histopathology service in Nigeria. Nigerian Medical Journal: Journal of the Nigeria Medical Association, 61(4), 180.

Hanna, M. G., Ahmed, I., Nine, J., Prajapati, S., & Pantanowitz, L. (2018). Augmented reality technology using Microsoft HoloLens in anatomic pathology. Archives of Pathology & Laboratory Medicine, 142(5), 638-644.

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