Subscribe to RSS
Remote Digital Microscopy Improves Hematology Laboratory Workflow by Reducing Peripheral Blood Smear Analysis Turnaround TimeFunding None.
Background The demand for morphological diagnosis by peripheral blood smear (PBS) analysis with clearly defined turnaround times (TAT), coupled with a shortage of morphologists and increasing cost containment, is driving digitalization to the forefront of laboratory workflow. Labor-intensive manual PBS review affects weekend workflow with limited staff availability. The impact of remote analysis of PBS on the performance of hematology laboratories has not yet been assessed.
Objectives Following implementation of fully remote digital microscopy within our laboratory, we measured its impact on morphology workflow efficiency, TAT, and hours saved per month.
Methods A retrospective study of the effects of remote PBS analysis on the morphology workflow in a tertiary medical center using the Scopio Labs X100 Full-Field PBS system was conducted. 10,704 PBS samples were analyzed pre-and post -implementation, over a 5-month period. Overall PBS workload, and average TAT of PBS samples over weekends and the first two weekdays were collected and evaluated.
Results Remote weekend viewing resulted in a 15.8% reduction in the overall morphology TAT of the laboratory (p <0.03) over a 5-month period, despite similar overall workload. PBS analysis TAT on Fridays was reduced by 41.4% (p <0. 006), and by 59.1% on the first weekday (p <0.02). The additional hours incurred over the weekend were offset against a reduced need for double weekday shifts resulting in approximately 12.76 work hours saved per month. Internet links to clinically relevant cases are provided.
Conclusion The Scopio Labs Full-Field X100 PBS system with remote analysis capacity significantly reduced PBS TAT and improved the morphology workflow of the hematology laboratory. PBSs with significant clinical findings are now available for remote viewing by on-call clinicians located outside the medical center perimeter. Remote PBS viewing, coupled with the overall monthly cost savings, merit consideration for the implementation of full digitalization for remote PBS review.
Keywordsdigital - efficiency - hematology - morphology - peripheral blood smear - remote - workflow
Protection of Human and Animal Subjects
The study was performed in compliance with the World Medical Association Declaration of Helsinki on Ethical Principles for Medical Research Involving Human Subjects, and was approved by TASMC Institutional Review Board. Animal subjects were not included in the project.
Received: 12 July 2022
Accepted: 20 September 2022
Accepted Manuscript online:
08 October 2022
Article published online:
23 November 2022
© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
- 1 Walter W, Haferlach C, Nadarajah N. et al. How artificial intelligence might disrupt diagnostics in hematology in the near future. Oncogene 2021; 40 (25) 4271-4280
- 2 Kratz A, Lee SH, Zini G, Riedl JA, Hur M, Machin S. International Council for Standardization in Haematology. Digital morphology analyzers in hematology: ICSH review and recommendations. Int J Lab Hematol 2019; 41 (04) 437-447
- 3 Brereton M, De La Salle B, Ardern J, Hyde K, Burthem J. Do we know why we make errors in morphological diagnosis? An analysis of approach and decision-making in haematological morphology. EBioMedicine 2015; 2 (09) 1224-1234
- 4 Briggs C, Longair I, Slavik M. et al. Can automated blood film analysis replace the manual differential? An evaluation of the CellaVision DM96 automated image analysis system. Int J Lab Hematol 2009; 31 (01) 48-60
- 5 Breil B, Fritz F, Thiemann V, Dugas M. Mapping turnaround times (TAT) to a generic timeline: a systematic review of TAT definitions in clinical domains. BMC Med Inform Decis Mak 2011; 11: 34
- 6 Katz BZ, Feldman MD, Tessema M. et al. Evaluation of Scopio Labs X100 Full Field PBS: the first high-resolution full field viewing of peripheral blood specimens combined with artificial intelligence-based morphological analysis. Int J Lab Hematol 2021; 43 (06) 1408-1416
- 7 Radakovich N, Nagy M, Nazha A. Machine learning in haematological malignancies. Lancet Haematol 2020; 7 (07) e541-e550
- 8 Palmer L, Briggs C, McFadden S. et al. ICSH recommendations for the standardization of nomenclature and grading of peripheral blood cell morphological features. Int J Lab Hematol 2015; 37 (03) 287-303
- 9 Nakashima MO, Doyle TJ, Phelan-Lewin K, Summers JM, Bena J, Hsi ED. Assessment of semi-quantitative grading of red blood cell abnormalities utilizing images from the CellaVision DM96 compared to manual light microscopy. Int J Lab Hematol 2017; 39 (05) e110-e112
- 10 Saha M, McDaniel JK, Zheng XL. Thrombotic thrombocytopenic purpura: pathogenesis, diagnosis and potential novel therapeutics. J Thromb Haemost 2017; 15 (10) 1889-1900
- 11 Thomas MR, Scully M. How I treat microangiopathic hemolytic anemia in patients with cancer. Blood 2021; 137 (10) 1310-1317
- 12 Aeffner F, Adissu HA, Boyle MC. et al. Digital microscopy, image analysis, and virtual slide repository. ILAR J 2018; 59 (01) 66-79
- 13 Eloy C, Vale J, Curado M. et al. Digital pathology workflow implementation at IPATIMUP. Diagnostics (Basel) 2021; 11 (11) 2111
- 14 Jahn SW, Plass M, Moinfar F. Digital pathology: advantages, limitations and emerging perspectives. J Clin Med 2020; 9 (11) 3697
- 15 Retamero JA, Aneiros-Fernandez J, Del Moral RG. Complete digital pathology for routine histopathology diagnosis in a multicenter hospital network. Arch Pathol Lab Med 2020; 144 (02) 221-228
- 16 Baidoshvili A, Bucur A, van Leeuwen J, van der Laak J, Kluin P, van Diest PJ. Evaluating the benefits of digital pathology implementation: time savings in laboratory logistics. Histopathology 2018; 73 (05) 784-794
- 17 Ho J, Ahlers SM, Stratman C. et al. Can digital pathology result in cost savings? A financial projection for digital pathology implementation at a large integrated health care organization. J Pathol Inform 2014; 5 (01) 33
- 18 Hanna MG, Reuter VE, Samboy J. et al. Implementation of digital pathology offers clinical and operational increase in efficiency and cost savings. Arch Pathol Lab Med 2019; 143 (12) 1545-1555
- 19 Halms T, Strasser M, Kunz M, Hasan A. How to reduce mental health burden in health care workers during COVID-19? – a scoping review of guideline recommendations. Front Psychiatry 2022; 12: 770193
- 20 Savić D. COVID-19 and work from home: digital transformation of the workforce. Grey J 2020; 16: 101-104