[Histonet] AW:cont. workflow

Tue Jan 7 12:27:48 CST 2014

I'm curious.  How many techs do you have working in your lab that you are able to complete 300 blocks including IHC, FISH, etc in 9 hours?  Do your techs also gross?  Do your techs put the slides together in folders with reports to be distributed to the pathologists?  

Thanks,

Barbara S. Tibbs
Histology Supervisor
Accurate Diagnostic Labs
South Plainfield, NJ
barbara.tibbs <@t> accuratediagnosticlabs.com
732-839-3374
Cell: 610-809-6508

________________________________________
From: histonet-bounces <@t> lists.utsouthwestern.edu <histonet-bounces <@t> lists.utsouthwestern.edu> on behalf of Gudrun Lang <gu.lang <@t> gmx.at>
Sent: Tuesday, January 07, 2014 2:44 PM
To: 'Lee & Peggy Wenk'
Cc: histonet <@t> lists.utsouthwestern.edu
Subject: [Histonet] AW:cont. workflow

Hi Peggy!
You talk about a lab with many specimens, many blocks.
What do you think is the number of blocks, where a change from "batch" to
"flow" makes sense?

We have about 300 blocks per day and work from 6.30 till 15.30. Usually we
are ready with slide-distribution at noon. And we do also IHC, FISH,
mutation analysis, IF , many fast frozens- so we are busy, when we are not
dealing with routine-histology.
And we are happy with our system. ;-) Fixation is all in a comparable range.
TAT of biopsies is one day after entry (patients are called in usually one
week afterwards from the clinicians...). And we have a very diversified
workplace with comfortable workshifts.

Advisers often hold up cont. workflow as best, but I think it must fit to
the circumstances!

Gudrun Lang

-----Ursprüngliche Nachricht-----
Von: histonet-bounces <@t> lists.utsouthwestern.edu
[mailto:histonet-bounces <@t> lists.utsouthwestern.edu] Im Auftrag von Lee &
Peggy Wenk
Gesendet: Montag, 06. Jänner 2014 18:31
An: Podawiltz, Thomas; Deanna Leslie; histonet <@t> lists.utsouthwestern.edu
Betreff: Re: [Histonet] Soaking artifact

In most labs, the processor runs all night long. Someone comes in very early
in the morning, empties the processor, starts the purge cycle, and then
starts embedding a lot of blocks.

The tissue processor then sits, doing nothing, from after the purge in the
early morning, until sometime in the late afternoon, when all the tissues
are loaded in for the overnight run. That means the tissue processor is
doing nothing for up to 12 hours during the daytime.

How about, besides the overnight run, we can set up 1 or 2 other shorter
runs during the day, with the small biopsies.

How about - process all the large tissues overnight, but keep the little
biopsies that you grossed all afternoon in formalin until the morning. Empty
out the large tissues, purge the process, embed the large tissues and start
microtoming them.

After the purge is done, put the small biopsies from the afternoon on the
tissue processor, and process them for 1.5-2 hours (and if your processor is
able to process half a load, do that to save on reagents). Then embed them
and start microtoming them. Purge the processor again.

In the mean time, all morning, collect the small biopsies again. After
lunch, short process all the small biopsies from the morning. Embed them in
the afternoon, purge the processor again, and load up the overnight load.

If you don't have time to microtome the morning small biopsies (that you
embedded in the afternoon), someone can microtome them in the morning the
next day. Either with the large overnight load, or have someone else come in
early, and while the other people are embedding the large tissue overnight
load, they can be microtoming the small biopsies that were embedded in
previous afternoon.

Yes, all of this will mean changes:
- staggered hours that people will be coming in
- processing, embedding and microtoming continuously throughout the day
- someone might have to microtome more than someone else, or might have to
embed more than someone else. But if you rotate jobs around, over the
months, everyone ends up doing the same amount of work overall.

This is a type of continuous work flow, and does lead to faster turn around
time and efficiency.

When our lab changed to this system (we are an 1100 bed hospital, with lots
of tissues from our ORs, from outside hospitals and clinics and doctors
offices, so lots and lots of blocks), it took getting everyone involved -
people accessioning, grossing, the histotechs, and the pathologists (they
were not going to get their slides in numerical order). We have short
cycles, the overnight long cycles, some rush cycles, and long cycles for
breast and autopsy brain. We actually have more than 3 runs, but then we are
working almost 24/7. During the time we were switching to continuous work
flow, we had a few histotechs off on maternity and/or medical leaves. And we
got a couple more clients, so the work load increased. But because of the
continuous work flow, we were able to handle the additional work without
having to hire anyone.

Whereas before, we would process ALL the blocks overnight, and then would
have lots of people embedding lots of blocks first thing in the very early
morning, and then having to put in the in order, and no one could start
microtoming until all the blocks were embedding and in order (so some days
the microtoming techs were sitting around with nothing to do for a time).
Then, everyone had piles of blocks to cut, for blocks 100-150 were going to
be cut hours and hours after everyone started microtoming blocks 1-50. Then,
there were racks and racks of slide piling up to be stained with H&E (and at
that point, we were still labeling after staining). So there were all these
spots where tissue was being held up, unnecessarily:
- waiting to be processed
- waiting to be embedding
- waiting to be microtomed
- waiting to be stained
- waiting to be labeled
- then the pathologists had stacks of slides, waiting to be diagnosed
- waiting for the reports to be typed

With continuous flow, there is always some work coming through, but not
large piles causing long waits.

It just takes rethinking how you can use the processor more efficiently,
which will make the rest of the work more efficient. And increase
productivity and make turn around time faster.

Peggy A. Wenk, HTL(ASCP)

-----Original Message-----
From: Podawiltz, Thomas
Sent: Monday, January 06, 2014 12:04 PM
To: Lee & Peggy Wenk ; Deanna Leslie ; histonet <@t> lists.utsouthwestern.edu
Subject: RE: [Histonet] Soaking artifact

I agree Peggy. Just one question. What is a small histology lab to do when
they only have one processor and cannot run separate cycles and do not have
staffing to run short cycles throughout the day?

Tom Podawiltz HT (ASCP)
Histology Section Head/Laboratory Safety Officer.
LRGHealthcare
Laconia, NH 03246
603-524-3211 ext: 3220

-----Original Message-----
From: histonet-bounces <@t> lists.utsouthwestern.edu
[mailto:histonet-bounces <@t> lists.utsouthwestern.edu] On Behalf Of Lee & Peggy
Wenk
Sent: Monday, January 06, 2014 8:07 AM
To: Deanna Leslie; histonet <@t> lists.utsouthwestern.edu
Subject: Re: [Histonet] Soaking artifact

The only "soaking" artifacts that I can think of would be caused by:
- soaking too long in water (minutes instead of a few seconds)
- soaking under-processed tissue in water

In both cases, the tissue is supposed to be "protected" by the wax, and if
it is not (under-processed), or if the faced block is in water too long, the
tissue can start re-absorbing water. The tissue then turns white and swells
out of the block. So all that "swelled out" tissue is cut away and lost when
the tissue is put back on the microtomy for sectioning the ribbon.

If you soak for just a few seconds, such as a gauze with water being held
against the block on the microtome, after it has been faced, then you will
get a little bit of water absorbed into just a few layers of cells. Just
enough to cut 2-4 sections. And you won't see that swelling artifact.

For those of you saying - "but I have to face all the blocks, put them back
on ice and/or water while I cut a bunch more blocks, and then go back and
cut each block" - that is an artifact also. You have over-dehydrated your
tissue during processing, and you are putting back the water that you should
not have taken out. Processing is supposed to remove the unbound water (not
attached to proteins), and some of the bound water (attached to proteins),
and leave some of the bound water (attached to proteins) in the tissue. If
you HAVE to soak EVERY block for more than a couple of seconds, then you are
wasting time rehydrating and wasting time while microtoming. Cut down the
time in the alcohols on the tissue processor, to leave a little bound water
in the tissues. And you can NOT processing little biopsies on the same long
processing cycle as the larger pieces of tissue (uterus, breast, etc.).
Those little biopsies will be over-dehydrated. They HAVE to be run on a
separate cycle of much shorter time intervals (10-20 minutes in each
solution (once fixed), instead of 45-60 minutes in each solution).

You should be able (on nearly every tissue block) to rough trim the tissue,
and immediately start cutting ribbons. Possibly, you will need to put an ice
cube on some of the harder tissue (cervix, uterus, bone, lens, etc.) just to
get the paraffin hardness to match the hardness of the tissue. That being
said, some tissues are naturally brittle or crumbly, and always need some
water put back in the tissue, such as spleen or bloody tissue, but again,
some wet gauze on the faced block for a few seconds should be enough time to
get 2-4 sections. And that's all the tissue we usually need from those
blocks. If you need more for IHC, put the wet gauze back on the faced block,
and cut a few more sections.

Peggy A. Wenk, HTL(ASCP)SLS

-----Original Message-----
From: Deanna Leslie
Sent: Sunday, January 05, 2014 4:42 PM
To: histonet <@t> lists.utsouthwestern.edu
Subject: [Histonet] Soaking artifact

Has anybody in histoland ever heard of this?  I have been cutting tissue for
25 yrs and until recently I had never heard of this!
I am under contract to a facility and the supervisor there does not want
anybody to soak their tissue or use ice!  Your are supposed to use the cold
plate, because as I have stated soaking them causing an artifact. I have not
disputed this because it is not my place or in my job discription as a
traveler.  I am not even sure what it is supposed to look like or what type
of problems it causes.

Thanks for listening!
Deanna Leslie HT ASCP
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