Improving efficiency in dermpath

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Brock Lee

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A question for actively practicing dermpaths: could you share some advice on how to improve efficiency?

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Your morning routine is really going to set the tone for the day, so make sure you get that locked down. If you shower at night, sleep in your clothes for the next day. If you shower in the morning, try combining it with brushing your teeth and a calisthenics workout routine. You want to double and triple up on activities wherever possible to really maximize your time investment. Everything else will naturally flow from there.
 
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Not sure exactly what you mean, but my key efficiency tip is to triage cases. And for that I mean don't get hung up on a tough one when there are lots of easy ones you could burn through fast. If a case is even remotely challenging I take it off the tray and put it aside for later, then continue the tray and get through all the easy cases - nevi, BCCs, etc. Then, once the easy ones are done I come back to the tougher cases and give them more time, decide if they need stains/levels etc. If I am rather stumped I'll show them around and get other opinions.
 
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Could you elaborate more on what you're looking for? Is this efficiency in the lab? Efficiency in reading cases? Efficiency for ordering/resulting? There's lots of steps to consider. I suggest you check out pathologywatch.com to see how going digital can also help.
I had a Eureka moment. The OP is a mid-manager type in some dermpath mill, looking for ways to squeeze the most 88305s from dermpaths.
 
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I had a Eureka moment. The OP is a mid-manager type in some dermpath mill, looking for ways to squeeze the most 88305s from dermpaths.
I can assure you I am definitely not this! I'm an MD path-trained dermpath. Thanks for your suggestions in the derm subforum, by the way.

Could you elaborate more on what you're looking for? Is this efficiency in the lab? Efficiency in reading cases? Efficiency for ordering/resulting? There's lots of steps to consider. I suggest you check out pathologywatch.com to see how going digital can also help.

All of those.

We made some changes to our lab workflow that have helped tremendously, resulting in fewer slides per case. For instance we do 3 levels on a punch now rather than the 9 serials over three slides we used to do. We are still having issues with techs not being able to sample the entire epidermis on excisions, so getting full faced sections slows us down somewhat. It is annoying to have to revisit a case later that you've already examined because the last block wasn't sectioned full face.

Reading cases efficiently is always something that can be improved. When I get inflammatory biopsies from dermatologists it's pretty straightforward. When I get them from family doctors, it's challenging and these tend to take a lot of my time because I have no idea what the clinical impression is, and even if I do I don't know if I can trust it, so there's a lot of hedging on my part. What happens with these cases on your end? Anyone else too?

My neck and I wish we could go digital but that's not in the cards at this point. Cost ratio is too high and our practice skews vintage.
 
I can assure you I am definitely not this! I'm an MD path-trained dermpath. Thanks for your suggestions in the derm subforum, by the way.



All of those.

We made some changes to our lab workflow that have helped tremendously, resulting in fewer slides per case. For instance we do 3 levels on a punch now rather than the 9 serials over three slides we used to do. We are still having issues with techs not being able to sample the entire epidermis on excisions, so getting full faced sections slows us down somewhat. It is annoying to have to revisit a case later that you've already examined because the last block wasn't sectioned full face.

Reading cases efficiently is always something that can be improved. When I get inflammatory biopsies from dermatologists it's pretty straightforward. When I get them from family doctors, it's challenging and these tend to take a lot of my time because I have no idea what the clinical impression is, and even if I do I don't know if I can trust it, so there's a lot of hedging on my part. What happens with these cases on your end? Anyone else too?

My neck and I wish we could go digital but that's not in the cards at this point. Cost ratio is too high and our practice skews vintage.
Basics to consider - barcode tracking and a good LIS system. EMR ordering with preset clinical info/impression choices. Good QA/QC procedures for the lab. If you want more info, PM me.
 
When they sell their practice to VC, the VC lab that they start using will be very efficient.
 
Many ways to optimize a small biopsy service (including derms).

In my experience some of the best and easy ways to gain efficiencies:

- both levels on ONE slide. We spend more time than you think just picking up glass. This eliminates half of the slide pick ups

- eliminate dictation. Build templates and quick texts that are easy to enter either with voice prompts or minimal key strokes. This allows you to study a case and in just a few seconds have the diagnosis entered / case sign out. Also a HUGE patient safety issue to be able to scan into a case (assuming you have slide scanning) and release it before you pick up the next case. Less chance of dictating finding into another’s case.

- block time on your calendar for sign out.
No one knocks on your door between 9 am - 1030 (or whatever your preferred time to sign out cases) & your phone goes to support staff. W/o interruptions you can knock out a ton of biopsies. I can probably sign out 40 - 50 biopsies (GI / gyn /derm) in 90 mins so long as I am not interrupted.
 
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Thanks for the tips I found here at this thread. I am less than 2 years into practice and I feel I need to work on my speed, I also tend to do lots of levels and stains. What percentage of your cases do you roughly do stains on, particularly melanocytic? I also hate these tough squamous lesions superficially sampled. any advice is appreciated.
 
Thanks for the tips I found here at this thread. I am less than 2 years into practice and I feel I need to work on my speed, I also tend to do lots of levels and stains. What percentage of your cases do you roughly do stains on, particularly melanocytic? I also hate these tough squamous lesions superficially sampled. any advice is appreciated.
It probably varies from dermpath to dermpath and lab to lab. I know some dermpaths that stain anything even remotely brown. Although they are doing so to pad their bank accounts, not because they need the stain to make the diagnosis. I would say I get stains on anything melanocytic that I have the slightest doubt about, which likely works out to around 20% of those cases. I tend to stain lentigines on the head/face of elderly patients as I've seen some very subtle atypical proliferations that were nearly invisible on H&E. But obvious nevi, obvious MMIS, obvious melanoma I do not routinely stain unless it will assist in margin evaluation or I'm trying to rule out LVI or something. I'm fairly liberal with levels as there have been many times something has popped up on the deepers that wasn't there at all on the original slide. And my lab gets 3 levels per slide on all small biopsies which is convenient and uses less glass/time.
 
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I can assure you I am definitely not this! I'm an MD path-trained dermpath. Thanks for your suggestions in the derm subforum, by the way.



All of those.

We made some changes to our lab workflow that have helped tremendously, resulting in fewer slides per case. For instance we do 3 levels on a punch now rather than the 9 serials over three slides we used to do. We are still having issues with techs not being able to sample the entire epidermis on excisions, so getting full faced sections slows us down somewhat. It is annoying to have to revisit a case later that you've already examined because the last block wasn't sectioned full face.

Reading cases efficiently is always something that can be improved. When I get inflammatory biopsies from dermatologists it's pretty straightforward. When I get them from family doctors, it's challenging and these tend to take a lot of my time because I have no idea what the clinical impression is, and even if I do I don't know if I can trust it, so there's a lot of hedging on my part. What happens with these cases on your end? Anyone else too?

My neck and I wish we could go digital but that's not in the cards at this point. Cost ratio is too high and our practice skews vintage.

Get a standing desk. You burn 200 extra calories per day, and it eliminated by neck strain (you come to use your lower body for correct positioning).
 
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