Post on 29-Dec-2015
The Bowel Screening Pilot:a pathologist’s perspective
Dr Nicole KramerAnatomic pathologist
LabPlus, Auckland City Hospital
Outline and approach
• Workload experience at LabPlus
• Expected workforce required
• Successes and stumbling blocks
Specimen services
Anatomic pathology
(tissue retrieved at colonoscopy)
Biochemistry(iFOBT)
Workload is for the Waitemata DHB population of 575,000 Additional laboratory workload not accounted for includes testing of patients as inpatients (haematology, biochemistry, microbiology), additional histology specimens and cytogenetics
Specimen services• All specimens are unpacked, checked (labelling, appropriate
request form), scanned and registered with a unique laboratory identifier
• Receive 39,000 iFOBT per annum• Receive 1462 histo cases/year (currently signed straight
through)• Assuming an average of 7 minutes/case
• 4450 hours/year • 87.5 hrs/week• 10% loading for leave (holiday etc.) 2.4 FTE
Chemical Pathology
• 39000 iFOBT specimens/year• Analytical time:
• 2 minutes/case 1300 hrs/year
• 25 hrs/week + 10% loading for leave
• 27.5hrs/week (scientist) = 0.7 FTE
• Chemical pathologist or senior clinical scientist required for oversight and governance for troubleshooting and quality assurance (time not included)
Anatomic pathology (AP) workload – administration and clerical work
Number of pots each month (2014)• Workload is variable• Accounting for highest
potential workload• 10 minutes/case
• 5.6hrs/week• Resections
• .25hrs/cancer• 0.4hr/week
0.17 FTEApril
MayJune
July
August
Septem
ber
October
November
December
January
Febru
aryMarc
h0
20
40
60
80
100
120
140
160
Number of cases received each month (2014 -2015)
Anatomic pathology workload – scientist/histotechnician
• Registration • Grossing/transfers• Embedding• Cutting sections• Quality control• Data collection and submission• 0.7 FTE technical staff
Immunoperoxidase fee 106
2 X Level Fee 12
LVL Level fee 5664
No Charge fee 5
Paraffin Block 5567
recut fee 1
rrw recut fee 2
special stain fee 11
Billing data for 2014
Buesa RJ. Productivity standards for histology laboratories. Annals of Diagnostic Pathology 2014 (2010); 107-24.
AP workload – pathologist: screening
2012 Qtr2
2012 Qtr3
2012 Qtr4
2013 Qtr1
2013 Qtr2
2013 Qtr3
2013 Qtr4
2014 Qtr1
2014 Qtr2
2014 Qtr3
2014 Qtr4
2015 Qtr1
2015 Qtr2
2015 Qtr3
Sum of Number Pots
323 1285 1688 1371 1410 1899 1193 1439 1870 2148 1609 1099 1104 413
Count of Lab Number
102 359 522 431 442 626 383 401 563 733 503 335 350 132
250
750
1250
1750
2250
Qtr2 Qtr3 Qtr4 Qtr1 Qtr2 Qtr3 Qtr4 Qtr1 Qtr2 Qtr3 Qtr4 Qtr1 Qtr2 Qtr32012 2013 2014 2015
2.60
2.70
2.80
2.90
3.00
3.10
3.20
3.30
3.40
3.50
3.60Average of Number Pots
Average of Average Number of Pots
Workload is variable8 minutes /pot – reviewing colonoscopy, reporting, additional sections, peer review 13-17 hrs/week Preparing and presenting at MDM 1hr/weekTroubleshooting, liaising with scientists, clinicians, data reporting, QAP (1-2hr/week)18 to 25hours/week – 0.5 to 0.6 FTE
Average Pots per Case 2012-2015
AP workload – pathologistresections
• 224 cancers in three years• 1.5 cases/week• 1.75 hrs of pathologist time/case• 2.6 hr/week• 0.6 to 0.7 FTE total
Standards and Quality Indicators in order to be able to be audited we may need to have some
additional quality indicators for AP. For example we need to have strong support from the laboratory information system.
Reporting and audit of a number of anatomic pathology quality indicators is desirable
• Extraction of data from reports is hampered by the lack of laboratory information systems support available
and the method by which the reports are generated
• Most recently data has been extracted ‘manually’ as part of an audit process
Summary
Expected FTEs for the current population screened at WDHB are estimated at: Specimen services – 2.4 FTE Chemical pathology – 0.7 FTE with oversight Anatomic pathology
Administration – 0.2 FTE Scientist/technicians – 0.7 FTE Pathologists – 0.6 - 0.7 FTE
Workload is variable and recruitment of an appropriate staff mix is required