The introduction of errors is a genuine concern in the pathology lab, where preanalytical errors, specimen labeling errors, and specimen loss can all occur during specimen collection, transit, and accessioning. For that reason, pathology labs have been using specimen tracking systems (STS), utilizing barcodes to help reduce errors. However, radio-frequency identification (RFID) may help further decrease specimen identification and tracking errors through continuous and automated tracking of specimens.
Specimen tracking systems: the current model
Errors in specimen identification in the pathology lab can cause serious harm, especially in diagnostic anatomical pathology, which can impact patient care by providing definitive diagnoses of disease. As such, to protect patients from errors and ensure they are given the proper treatment, a variety of quality control initiatives have been put into place, the primary of which is the implementation of a specimen tracking system in the lab.
However, steps to reduce errors in the pathology must include every step of the process, whether introduced by a lab professional or a nonlaboratory provider. As such, quality control measures must include the preanalytical phase, during sample collection, the analytical phase in the lab, as well as the postanalytical phase, which can occur wherever the diagnostic report is delivered and the pathology slides and cassettes are stored1.
The STS uses barcodes along with tracking software to track a sample throughout the entire analytical process. Samples can be assigned a barcode upon arriving at the lab, thereby encoding the samples’ identification number with an associated barcode. This eliminates the need to re-label samples at various steps of the process, facilitating tracking of the sample. Thus, with a barcode tissue tracking solution, each patient has a unique identification number, along with a barcode that represents the ID number in a scannable form. In addition, tissue cassettes can be printed with the barcode, which can then be scanned during the grossing process to ensure the wrong cassette is not used. If an error does occur, it will be flagged and recorded, enabling the lab to determine the cause of the error and prevent further errors. Barcodes can also be printed and applied to microscope slides used for histology purposes. The STS ensures only one patient’s samples are manipulated at a time while providing location and user information for enhanced traceability.
Barcodes vs. RFID
The current system using barcodes can be further improved to better encompass the other phases of the pathology process and solve certain inherent work performance problems. Using barcodes has delivered significant improvements to sample tracking and has proven value in reducing errors and improving quality. However, they have certain limitations that RFID may be able to overcome. One issue is the need to scan the barcodes at each stage manually. If technicians fail to, or forget to scan the samples, the added tracking information will not be recorded, rendering the barcodes superfluous. Moreover, a specimen tracking infrastructure is also needed to reduce preanalytical errors between specimen collection and laboratory accessioning.
Implementing an RFID system on top of the existing STS offers a range of benefits and solutions to the problems associated with barcode specimen labeling and management2. This new specimen management system incorporating RFID technology would greatly improve mass specimen processing, offer greater durability in a range of temperatures and conditions, and enhance overall sample tracking. This can be achieved by automating the reading process so staff no longer have to manually scan samples, thus minimizing the required amount of labor. RFID tags would allow information to be electronically written and stored, offering greater data capacity and added security features. In addition, as they can be scanned without a line-of-sight requirement, multiple samples can be scanned simultaneously and in real-time. Moreover, RFID labels and tags offer relatively greater resistance to harsh chemicals and processing environments, as there is no printout that will smudge or smear. Of course, RFID labels can also be printed with barcodes, allowing pathology labs to have the best of both tracking systems.
Results of Implementing RFID for specimen Tracking
A number of clinical and pathology labs have run trials using such an RFID system to determine what benefits it can actually offer in a real-life lab setting. In a trial run in a bone marrow transplant unit, the use of RFID technology led to an 83% reduction in process errors and a 10% reduction in labor expenses3. Two studies conducted in anatomic pathology departments observed significant decreases in both minor and clinically significant labeling errors after introducing RFID to an outpatient practice, also reporting significant workflow efficiencies3. Another study, using HF RFID tracking led to a significant decrease in the number of mislabeled or unlabeled specimens, from a baseline of 765 to 47 (93%)3. Notably, only two of those errors had the potential to cause patient harm, with both identified and corrected before patient harm could occur.
Recently, the Mayo Clinic has also implemented an enhanced form of RFID tracking in order to better track patient samples. Mayo Clinic’s Department of Laboratory Medicine and Pathology upgraded its RFID technology in 2019 and published two peer-reviewed studies analyzing that implementation in 2020. Importantly, they showed improved specimen tracking during the preanalytical phase, from the point of collection to the lab.
Overall, the implementation of RFID has been shown to minimize potential specimen-loss events, as well as to decrease specimen labeling errors, at every phase of the pathology process. With its ability to provide real-time tracking, bulk specimen scanning, and greater data security, any increases in labeling/tracking expenses necessary to implement an RFID system are more than offset by time savings and error mitigation.
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- A new specimen management system using RFID technology. Hun Shim, Young Uh, Seung Hwan Lee, Young Ro Yoon. J Med Syst. 2011 Dec;35(6):1403-12.
- Radiofrequency identification specimen tracking in anatomical pathology: pilot study of 1067 consecutive prostate biopsies. David G Bostwick. Ann Diagn Pathol. 2013 Oct;17(5):391-402.
- Radio-Frequency Identification Specimen Tracking to Improve Quality in Anatomic Pathology. Andrew P Norgan, Kurt E Simon, Barbara A Feehan, Lynn L Saari, Joseph M Doppler, G Scott Welder, John A Sedarski, Christopher T Yoch, Nneka I Comfere, John A Martin, Brian J Bartholmai, R Ross Reichard. Arch Pathol Lab Med. 2020 Feb;144(2):189-195.