Enhanced technology safeguards patient specimens
Every patient sample collected for lab testing holds information hidden inside waiting to be revealed. A test may show that all is well, or it could expose a diagnosis that requires immediate care. It may uncover the reason for mysterious symptoms, or point to the need for another course of treatment. In many cases, laboratory test results open the door to the next step in a patient's care journey.
In order to unlock that information, though, each specimen must be carefully shepherded from the location where it is obtained to the lab bench. It's a process that's closely regulated and monitored, and lost, misplaced, or mislabeled specimens are rare. But it does happen. And when it does, obtaining a replacement sample may be difficult or impossible, as well as emotionally taxing for all involved.
In an effort to further reduce the risk of missing specimens, Mayo Clinic has implemented an enhanced form of radio-frequency identification (RFID) to track patient samples. In collaboration with key clinical partners, 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. The results showed improved specimen tracking and heightened protection of valuable — sometimes irreplaceable — patient samples as they wend their way from the point of collection to the lab.
RFID technology involves affixing custom-printed labels to an item, and then using RFID readers located along the route that item travels to monitor its progress. This technology isn't new. It's used to track everything from online retail orders to pizza deliveries. To date, however, it hasn't been widely employed in health care settings.
"Many industries are far ahead of health care in use of this technology," says R. Ross Reichard, M.D., a Mayo Clinic pathologist and one of the leads on Mayo's RFID project. "Think about the specificity of tracking items shipped through delivery services. You can know where your package — and even your pizza — is located more accurately than many specimens that go from a clinical practice to a lab for testing."
High cost and technology limitations have played a role in health care's reluctance to embrace RFID. Mayo Clinic has been out in front in its use of RFID, though, implementing a pilot project in 2007 to track specimens en route from the Department of Gastroenterology to the Division of Anatomic Pathology. Analysis of that project found a 93% decrease in the number of mislabeled or unlabeled specimens, from a baseline of 765 to 47 within the first three months of transitioning from manual tracking to RFID.
As the original equipment used in the pilot became obsolete over time, project proponents saw an opportunity for further improvement. Advances in technology and reduction in costs made upgrading to an ultrahigh-frequency RFID system feasible in 2019. With the new system, specimens can be tracked individually as they travel in batches from the clinical setting to the lab, with no need for them to be handled manually at any point during transit. Readers located strategically along the automated route record the location of each RFID label as it moves past each reader.
"The amount of staff effort required with the old system was definitely greater than with the new system," says John Martin, M.D., a Mayo Clinic gastroenterologist who was integral to implementing the upgraded RFID technology. "That reduction in effort is important because we're talking about nurses and technicians who have plenty of other work to do when caring for patients."
"The new system shows statistically significant improvement in mitigation of specimen loss and errors, while gaining back important staff effort, and saving the institution money. And the old system was no longer viable anyway. It was a substantial gain with essentially no losses."John Martin, M.D.
Another advantage to the new system is that it promptly sends out a notification if a specimen appears to have been diverted from its course. The team worked to estimate the maximum amount of time it should take to for a specimen to get from one reader to the next. If a specimen doesn't reach a touchpoint in time, an email alert goes out to all the supervisors, so they know there is a missing specimen.
"That means within a short period of time from the point a specimen has gone missing, people are looking for it," Dr. Reichard says. "That's crucial because all the same people are still there, and the environment is still basically the same. Previously, you might not know a specimen is missing until someone comes looking for the results, and that could be several days later. The chances of recovery at that point are very slim."
In the six months after the ultrahigh-frequency RFID system was installed, six mislabeling events occurred in collection areas, compared with 24 events in the six months prior to system implementation — a 75% decrease. In addition, the system led to the timely recovery of three lost specimens. Labeling expenses also were decreased substantially in the transition to ultrahigh-frequency RFID tags.
So far, the new RFID system has been successfully implemented in three clinical departments at Mayo Clinic: Gastroenterology, Dermatology, and Interventional Radiology — with significant potential to expand to more areas in the future. For Dermatology, a group that hadn't used the previous RFID system, the change has been particularly valuable.
"We're a practice that's quite unique in that we generate a high volume of specimens daily; our specimens are usually small; and we typically average two or three specimens per patient," says Nneka Comfere, M.D., a Mayo Clinic dermatologist and division chair of Dermatopathology. "Thus the specimen collection process is prone to error, given that you're labeling multiple specimens from the same patient. RFID allowed for the linkage of clinical applications for specimen orders and label generation, and the automation of specimen accessioning resulting in a substantial reduction of specimen errors.
"Maintaining the integrity of each specimen from the point of collection, through labeling, transport to the lab, testing, and result generation is crucial. This system has allowed for that."Nneka Comfere, M.D.
The opportunity to work with colleagues in the clinical setting, assessing their needs and examining the entire specimen process from beginning to end, is not the norm, according to Dr. Reichard. "Usually, pathologists receive the specimens, and we just have to deal with what we get and the way we get them. Here, we're on the same team. It's a different dynamic, and it allows us to collaborate in a unique way," he says. "Because we're all part of the same organization at Mayo Clinic, we can come together and have a discussion about this kind of process holistically."
Dr. Martin agrees that Mayo Clinic is distinctly well-suited to tackle projects like this that span a variety of disciplines and perspectives. "This project underscores the value of our team approach," he says. "We're able to accomplish this because we don't have an 'us vs. them' attitude at Mayo Clinic. It's 'we.' The importance of the collaboration for the good of the patient in this scenario cannot be overstated."
Guided by a patient-centric philosophy, Mayo Clinic Laboratories has a unique internal structure of quality specialists, coordinators, and engineers who constantly evaluate and improve laboratory operations. This structure supports a host of quality assurance activities.
Each day, some 40 to 45 thousand specimens are shipped to Mayo Clinic Laboratories in Rochester, Minnesota, from hospitals and other health care organizations around the world. And for every sample, there’s a patient to whom it belongs, someone on the other end hoping for answers to a challenging, perhaps even life-threatening, condition.
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