[Histonet] Pre-labeling glass slides

Rene J Buesa rjbuesa <@t> yahoo.com
Fri Mar 16 14:00:37 CDT 2007

OK, now you are talking about the "dreaded" work, the "B" word, the BATCH that if one wants to be efficient has to be small and dealt with as soon as possible.
  What you are writing about is a DIVISION of the workflow into several small batches or subunits to be dealt with effciciently and quickly.
  That is NOT LEAN, that is common sense streamlining, as well as the ubication of the different stations to reflect the sequence in the work flow. I did that in all the labs I have managed since before the people began talking about Lean.
  Lean is a concept, a managerial idea whose GENERAL principles can be adapted to histology but whose initial factory approach of almost zero inventory and productivity program are essentially incompatible with the histology flow that is completely dependant on the time the tissue is processed that in its turn is indepandent of all the pre-processing and post-processing tasks.
  Even the "elleged" Lean tissue processor by Sakura (the Xpress) promoted as "lean" needs the preparation of 30 to 40 cassettes batches requiring more time of pre and post-processing time than the real time dedicated to process (120 minutes if fixation is done previuously).
  Altough old and with 54 years of experience, I have always been open to new technologies. I consider myself as a fosil with a juvenile mind!
  René J.

Janice Mahoney <jmahoney <@t> alegent.org> wrote:
  Well Rene, I am and have been a Histo tech for over 20 years. I have been willing to change when I see things that will benefit the patient. I am a LEAN trainer and have implemented the LEAN principles in several labs. I did the DEEP STUDY in both LEAN and in Histology workflow. I can prove that LEAN will reduced TAT and errors while maintaining and even improving quality. To assume that LEAN will not work and that the principles are not applicable tells me that you do not know about the best part of LEAN and that is in the flexibility of it. There may be some "batching" but the smaller and less frequent the better. We still overnight process. In LEAN, when you are changing the "form, fit or function" of the specimen you are adding value to it. If something, like tissue processing, is necessary and cannot be eliminated could it be shortened or done in more frequent smaller "batches"?
It is Friday afternoon and I will stop. When I get on a roll about LEAN I cannot stop because I have seen the benefits in our lab and in others. Obviously I am a believer and I love to talk about it.
Rene, I hope we can meet sometime and continue this discussion in person. I always appreciate your insights on the histonet.

>>> Rene J Buesa 03/16/2007 11:23 AM >>>
As it hapened with Janice I can't keep quiet either.
Lets talk about LEAN.
To start with it is not applicable to the entire histology workflow.
The specimen arrives and somebody takes "hold" of it, number, access, describe AND??? that person will have to process it (unless it is a Frozen section). There has to be a delay and don't tell about the Xpress Sakura, it will have to wait until 30 or 40 cassettes will be ready before starting (and what do you call that if you don't want to call it a "batch"?)
It will come out after 120 minutes (or more time if it is a regular processor) and again another person will take the cassette in a "nurturing and loving embrace" and will prepare the slide, embed the tissue, section it, WAIT until it dries and will stain it. How long will it take to that "dedicated" histotech to have the slide ready for the pathologist and, most important, how much did that slide cost? What happened to the other cases? Is it a "one specimen a day"lab?
Trying to see the histology lab as the production line of a Toyota is unrealistic. Some aspects can be streamlined, others not.
The only process that is LEAN (and has always been without knowing it by the way) is the one performed by the histotech rushing over the piece of tissue received from the OR to do a FS, and even there I have seen some mislabellings (like some labs that do not access the tissue to do the FS).
Embracing new approaches require a deep study and knowing what we are getting into.
Just my opinion (as always)!
René J.

Douglas D Deltour wrote:
So it will save us time by having the tech get up and print the slide (using
the slide printer), go back to the microtome and cut it. This will happen
about 300+ times a night. Let's put two techs into the equation and one will
wait while the other is printing. If they do this I will not have to check
the slides for accuracy anymore? 

Douglas D. Deltour HT(ASCP)
Histology Supervisor
Professional Pathology Services, PC
One Science Court
Suite 200
Columbia, SC 29203
Fax (803)254-3262

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-----Original Message-----
From: histonet-bounces <@t> lists.utsouthwestern.edu 
[mailto:histonet-bounces <@t> lists.utsouthwestern.edu] On Behalf Of Janice
Sent: Friday, March 16, 2007 10:25 AM
To: Katri Tuomala; histonet <@t> lists.utsouthwestern.edu; Carmen Leschuk; Rene J
Subject: Re: [Histonet] Pre-labeling glass slides

I can't keep quiet anymore.
Single piece flow, one specimen, slide, case at a time is the fastest and
least error prone way of performing any task. It is LEAN and it can be
proven. Please consider it for the patient's sake.
i know that it seems more efficient to batch. I felt that way too before I
started seeing the processes in my lab with LEAN eyes. 
All those checks along the way are slowing down your process. If you single
piece flow, one case/slide at at time you will make fewer errors and no
longer need so many checks. You will get more slides out faster (with the
right number on them whether they are written or etched or labelled).

Janice Mahoney
Histology/Cytology Coordinator
Alegent Health Laboratory
4955 F Street
Omaha, NE 68117

>>> "Katri Tuomala" 03/12/2007 9:35 PM >>>
I totally agree with Rene. We pre-label all our slides in approximately 20 
slide lots. We have so many checks along the way, before the slides are 
delivered, that the odd mistake gets discovered very quickly.
You just have to pay attention to what you are doing.
And yes, I remember the diamond pens, ouch!!


Katri Tuomala
Hamilton, Ontario, Canada
----- Original Message ----- 
From: "Rene J Buesa" 
To: "Carmen Leschuk" ; 

Sent: Monday, March 12, 2007 12:44 PM
Subject: Re: [Histonet] Pre-labeling glass slides

> Carmen:
> Labelling the slides BEFORE they are used is the normal and logical 
> practice. In this way the slides can be ready beforehand. The thing is 
> that if the person using the slides does NOT pay attention, the 
> "misslabelling" can occur.
> On the other hand the amount of time you could WASTE by leballing 
> simultaneously while sectioning is astronomical.
> The good practice is to have a log with the blocks to section, prepare 
> all the labelled slides in the needed amount and BEFORE sectioning the 
> blocks, match slides to blocks and that is all you have to do.
> Sloppines and carelessnes are the roots of any mistake in histology. The 
> solution is to pay attention, not to misuse a slides writing machine.
> René J.
> Carmen Leschuk wrote:
> Recently, I heard of a slide mislabeling that occurred in another histo 
> lab that they determined to be caused by pre-labeling slides before actual

> use at the microtome. This lab said that if the slides would of been 
> labeled simultaneously (per their policy) as the blocks being cut, the 
> mislabeling would of been prevented. My lab currently pre-labels all of 
> slides before cutting a sequence of 10-20 blocks, which I thought was 
> common practice. My question is, what is common practice? Do other labs 
> have poli
> cies forbidding pre-labeling of glass slides?
> Carmen Leschuk, HT, SLS (ASCP)
> Supervisor, SJMO-Anatomic Pathology
> (248)858-6231
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