Story courtesy Saskatoon City Hospital Foundation

Tracey looks at the specimen under her microscope. It’s one of many she’s looked at today and definitely not the last. She knows that this specimen belongs to a real person and that the results could be devastating. Her fears are confirmed. The sample contains cancerous cells. She returns the sample to the cart that contains hundreds of similar samples. She must focus on the quality of the work before her.

The employees of Saskatoon City Hospital’s Surgical Pathology Lab work to beat the clock while producing quality work every day.

RR-2016-04-06-SCHF-LabDr. Fergall Magee, unified head of Pathology and Laboratory Medicine for Saskatoon Health Region notes that the majority of lab work within the pathology department involves cancer – determining if specimens contain cancer, what kind of cancer to determine correct treatment and, most crucially, if all of the cancer was removed.

In just a decade, the lab has seen significant growth in usage – five per cent in the last year alone, 24 and 41 per cent in the last five and 10 years. The number of certain types of breast pathology tests in the lab has increased by a staggering 240 per cent in the last four years.

However, the Surgical Pathology Division of Laboratory Medicine remained a manual area despite advances in technology due to the expense of that technology.

On an average day, up to 200 patient specimens are sent to the lab, notes Rhonda Hartz, manager of the Surgical Pathology Division of Laboratory Medicine. “This year alone will see more than 45,000 new individual  patient cases, and many patient cases have more than one specimen or slide to look at. We estimate those patient cases will translate to 320,000 slides the lab has to examine.”

Dr. Magee says the province’s success in reducing surgery wait times, a growing and aging population, and projected increases in cancer rates means these numbers are yet to peak.

With a budget stretched to capacity and technology aging, the struggle of those who work in the lab is obvious. Most urgent specimens are viewed and a minimum report made to the physician in eight days; some within three days. Full results are available an average of 20 days after with 85 per cent of urgent specimens being reported within eight days.

The Surgical Pathology Lab approached the Saskatoon City Hospital Foundation, asking it to help fund an extensive, three-phase plan to conduct major updates to lab equipment. The first of these phases, costing $1.277 million, would see the lab move from manual to automated processes to help staff meet the demands of their important work.

Equipment needed in this phase includes new microscopes/computers, biopsy processors, biomarker instrumentation, microtomes, cassette and slide labelers, gross dissection hoods, and capital improvements.

This is a crucial first step.

The next two phases will address issues such as automated tracking, which is not available in surgical pathology, though other areas of the laboratory do have this ability.

To patients, this means that currently, while their throat swab or blood sample is tracked, their biopsy specimen is tracked through labour-intensive manual processes.  The ability to bar code and track patient material has proven to reduce in-lab errors. The pathology lab is the last area of the lab to develop this technology, a significant step forward for patient safety.

This second phase, priced at $800,000 to $850,000, will see the purchase of tracking software. This will enable the lab to track blocks and slides through the system, allowing surgeons to request and immediately learn the status of samples. “That can happen currently,” Dr. Magee explains, “but it takes some time and involves several staff. Automated tracking would enable us to find a sample in the chain immediately.”

The Foundation recognized that the project was critical to meeting ever-increasing volumes and demand for fast turn-around on diagnosis. It shared the proposal with a private donor who was interested in learning more and agreed to a guided tour of the Lab. After explaining the need, the donor, who asked to remain anonymous, replied with a gift for more than $2 million – enough to fund both phases.

It also was one of the largest individual donations the Foundation has ever received. The Foundation is very grateful for this transformational gift.

The Foundation and the donor were compelled by the dedication of the staff and their capacity to make-do with limited resources. The current situation was eroding the confidence of lab staff to feel encouraged about their contributions to patients. Ultimately on the other side of the laboratory work are patients and physicians waiting for results and diagnoses.

“We were ready to proceed with the improvements the moment we had approval and the moment we received funding,” Dr. Magee says, noting the entire staff is very grateful for the gift.

He adds that improvements will greatly affect processing in the lab. “I think the best way to describe the situation is that we were running a bus service. But we also needed a taxi service for those specimens that need to be examined sooner. Thankfully, we can have that now.”

“Safety also will be vastly improved,” Hartz says. “We manually track every specimen in the lab and, as diligent as staff is, there is inherent risk for human error. The improvements we now can do will minimize that risk.”

A third phase, yet to be costed, will include the purchase of telepathology hardware and software. The technology will enable pathologists to share specimen views through electronic submission, establish regional and provincial interfaces to pathologists in outlying communities to share specimen views, and establish a link to a national pathology network.