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TalkingPoint's pivotal role in reducing histopathology turnaround times

Derriford Hospital’s Pathology Department received national acknowledgement of its quest to achieve earlier cancer diagnosis. Previously a department that was struggling to meet the national RCPath turnaround times (TAT) standards, the new ways of working have transformed results, raising the output to on or above the required standards for 7 and 10 days TAT and reduced the backlog of unreported cases from more than 500 to zero.

Following an extensive overhaul of its working practices, the introduction of lean principles and investment in key technology, the Derriford Pathology Department has been awarded a £50,000 award to mark its significant improvement in the turnaround time for cancer results.

Commenting on the success, Dr Dean Harmse, Head of Department Cellular Pathology at Derriford Hospital said: “Previous strategies had concentrated on looking at capacity issues and significantly staffing but in today’s climate we realised we needed to do more with less.  As a result, we looked at our ways of working, specifically in the laboratory, and went about changing the work flow and streamlining the reporting process to significantly reduce time and delays and improve our TATs”.

In the laboratory, the Pathology team set about re-structuring the work load and streamlining cases into red, yellow and green streams, (with red being most technically demanding and green the least).  Each stream is managed on a daily basis to ensure standards and targets were met.  This allowed a ‘first in first out’ approach to be taken.

As well as this change however was the streamlining of the reporting process, and the role both a digital template and voice recognition, in the form of TalkingPoint, had to play in the ability to cut reporting times.  On the back off the laboratory streaming process was the introduction and creation by the Derriford Pathology team of a digital template so that specimens could be digitally described macroscopically at the dissection stage and the description can be directly embedded in the electronic database.  This process eliminated the need for secretarial transcribing of the macroscopic report. Once the case comes to the pathologist for reporting, the pathologist can add the microscopic examination and the whole case is SNOMED coded and authorised live and immediately with no delays.

Furthermore, the adoption of TalkingPoint, the selected voice recognition system, played a pivotal role in allowing pathologists to report in real time and offering a level of immediacy in authorisation that traditional forms of reporting cannot replicate. 

The implementation of TalkingPoint transformed the reporting process and allowed for quicker turnaround times by simply removing the time delays involved in the traditional process of dictating, typing, returning and authorisation.  With TalkingPoint the pathologist can report, SNOMED code and authorise a case in real time. Simply put a case is reported, coded and authorised by the pathologist without the need for any secretarial input.  Commenting on the advancements voice recognition has brought to the process, Dr Dean Harmse said:  “Previously reports were dictated by the pathologist in batches onto a tape.  Once a batch of reports was complete it would be passed onto the secretary for typing and coding.  The request forms would then be returned to the pathologist to check the report on the electronic database and then authorize. At any one of these stages, delays naturally occur, be that hours or days, due to working hours, lunch breaks and holidays.  As a result, the immediacy and therefore time saving capabilities of a voice recognition system became the obvious choice in our crusade to improve and reduce TATs”.

In addition to helping improve TATs, TalkingPoint has also helped influence a change in working practices in the department, as secretarial roles were redefined.  Secretaries at Derriford Pathology Department are now less relied upon to type reports and instead can support pathologists in administrative duties, including diary management and meeting preparation, and in turn free up pathologists’ time to concentrate on core work.  Furthermore, pathologists are also experiencing the ability to work independently from their secretaries and can plan their working day according to their own patterns and demands. The department was also able to give up a secretarial post via natural wastage and help the Trust with its cost improvement strategy.

A key advantage is that TalkingPoint enables the pathologists to SNOMED code cases directly with speech recognition. This has dramatically improved the accuracy of SNOMED coding as there is no risk of secretarial transcription errors during the coding process. TalkingPoint also has a failsafe mechanism that alerts the pathologist if SNOMED codes are not entered.

Continuing to discuss the important role voice recognition has had in the process, Dr Dean Harmse adds: “Once any department has voice recognition working, it is self-propagating. When pathologists see the ability of the system it becomes a no brainer to adopt it.  It is invaluable and I would go as far as to say that I personally would never take a post in any laboratory that does not have speech recognition or a real commitment to implement it”. 

However he adds a note of caution that voice recognition must always be carefully integrated and never undertaken piecemeal. “Voice recognition is a piece of technology all healthcare environments should benefit from, but it does require changing ways of working for a number of staff, and therefore can be met with resistance” Dr Harmse continues.  “To mitigate this, ensure you choose the right system. Don’t do it in ‘steps’ by putting digital dictation in first and trying to convert. Ensure it works on a small scale first before rolling out and make sure training and in-house support is implemented and available continuously.  We worked very closely with TalkingPoint who prior to implementation, advised us how to upgrade our hardware and looked at our systems and databases prior to installation to enable a seamless integration.  Individual scripts were created and the fact that TalkingPoint integrates the voice recognition process with the medical database has allowed us to work on one system.  This was a crucial point for us as pathologists, as hands free working, without the need for manual keyboard work between databases, ensures we can focus on the specimen or case and definitely helps with reporting productivity”.

Introducing the specimen streaming process and other lean principles transformed the working practices of Derriford’s Pathology Department and as a direct result, enabled them to vastly improve their turnaround times.  The 3 day TAT there went from a baseline of 15% to meeting the national standard of 50%. The 7 and 10 day TAT improved from 38% and 48% respectively to just under 90%, exceeding the RCPath standard of 80% for both.  They removed their backlog entirely, reduced their turnaround times of more than 10 weeks for some cases to an average of 4 days for all cases and dramatically improved the patient care by reducing the delays in the diagnosis of disease including cancer.

Summing up Dr Dean Harmse said:  “Receiving the National Innovation award was the icing on the cake for what we had achieved.  We set out to improve our TATs and offer a better service to clinicians and ultimately the patient.  As a team, at every level, we completely changed the way we work to benefit our patients.  The transformation has been highly rewarding. The prize money of £50,000.00 will be used for further improvement in the department, particularly to expand the role of Biomedical Scientists in cut-up”.


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