The project used a microscope camera to reduce the turnaround time of morphology results reporting for critical patients presenting after hours to the emergency department.
Aim
To reduce the turnaround time of preliminary microscopic diagnoses of significant pathology changes in relevant patients to the emergency department, intensive care unit or outpatient clinics at Shoalhaven District Memorial Hospital, Nowra to less than five hours.
Benefits
- Improved turnaround time in reporting of morphology results
- Cost effective
- Helps physicians in early diagnosis and prognosis, thereby facilitating early treatment and better patient outcomes.
Background
Shoalhaven District Memorial Hospital laboratory is a 24/7 laboratory, but does not have a pathologist on site. Critical blood films or gram stained films can be provisionally screened by local staff, but must be transported to the larger laboratory at Wollongong Hospital for a pathologist review. The transportation of slides occurs via an internal courier service which operates between Wollongong hospital and the Shoalhaven District Memorial Hospital lab at 6.30am, 11am and 4pm. Outside of these times, there is no courier service, meaning that any urgent specimens requiring referral to the Wollongong laboratory must be transported by an expensive commercial taxi service. This can increase the turnaround time of reporting of critical microscopy results from five hours to 24 hours.
This project aims to reduce this turnaround time using digital morphology. A scientist at the local laboratory takes digital images with a portable microscope camera. These are then uploaded to a shared drive for a pathologist at the Wollongong laboratory to review and make a clinical judgement.
The use of digital morphology has been endorsed by local pathologists. Trial runs using the camera have proved that the turnaround time can be improved significantly, helping clinicians to make better diagnoses.
Implementation
Implementation of this project began in April 2019. The following steps were initiated.
- Sourcing of the microscope camera.
- Installation and testing of the camera took place, followed by discussions with pathologists to encourage the use of the camera after hours.
- Further testing and staff training on the use of camera was completed.
- Use of the camera began, with captured images being shared via email and network sharing with pathologists located at referral sites.
- Data was collected regarding the turnaround times of morphology results to support the continued use of camera.
Status
Implementation – The project is ready for implementation or is currently being implemented, piloted or tested.
Dates
The project began in April 2019 when the microscope camera was sourced and installed.
Between June 2019 and September 2019, the camera was tested and staff were trained on how to install and use it.
Images were also shared through email or shared network. The turnaround times of reporting of microscopic morphology by scientists and pathologists were measured.
Implementation sites
The project has been implemented at Shoalhaven Memorial District Hospital, Nowra.
Results
The turnaround time of reporting of microscopic morphology by pathologists and scientists before and after the implementation of the camera was measured. Critical morphology reporting that took 12 hours before the camera was reduced to less than five hours. The relevant times were obtained from OMNI LAB, electronic medical record, etc.
Lessons learnt
This project will be useful to pathology labs in rural or remote areas that don’t have a pathologist based on site, or trained morphologists to give expert advice when critical patients present to the emergency department after hours. These sites may not have a courier service afterhours to transport specimens to referral sites. The cost of the camera is reasonable, though local staff must have received sufficient training to be competent in interpreting morphology results and confident to use the camera. This may not happen if staff are on solo shifts and cannot spend time screening films as they are busy in other sections of the laboratory.
Further reading
Kanyi EM, Mwangasha L. Digital Microscopy: Making Diagnostics More Accessible; PSQH Online [Internet]; 2018 [Updated 2018 Aug 24; Cited 2019 April 20].
Acknowledgement
Project lead: Jayachandran Nair, former Laboratory Manager
Contact
Tendayi Mpande
Laboratory Manager
NSW Health Pathology
Illawarra Shoalhaven Local Health District
Phone: 02 4423 9303
Tendayi.Mpande@health.nsw.gov.au
