CASE STUDY

Tissue Processing

Excelsior AS Tissue Processing
and Efficient Workflow
University Hospital of Wales
Scott Gable is the Cellular Pathology Services Manager at
UHW Cardiff, managing a team of 50 full time equivalentstaff. In 2016, they processed almost 45,000 general surgicalrequests as well as over 15,000 speciality cases frompaediatrics, neuropathy, foetal and post-mortem pathology.
They are a regional neuro centre and provide a regional
service for vital breast HER2 screening. Last year, thosecases led to almost 149,000 H&E (Haematoxylin and Eosin)
stains being carried out. This places more pressure on Scottand his team to work in the leanest possible way to maximise
throughput and minimise waste.
In 2016, the Pathology Department at the University
Hospital of Wales Cardiff processed almost 45,000
patient cases, providing a vital service in the diagnosisof cancers and other diseases. The success of such ahigh-throughput laboratory relies on optimised workflow
and high-quality tissue processing. Their choice of tissue
processor? The Excelsior™ AS from Epredia.

ProfileUniversity Hospital of Wales in Cardiff first opened in 1971
and is part of the Cardiff University School of Medicine.
Previously part of Cardiff & Vale NHS Trust, the hospital is
now operated by the University Health Board and, as thelargest hospital in Wales, serves a population of over 450,000.
Lean workflow is a key part of their practice, helping them tomaximise throughput and achieve the best possible turnaround times despite ever-challenging financial conditions.

Tissue Processing and Lean Workflow
UHW Cardiff has an excellent lean
set-up for optimum laboratory
throughput. This includes
implementation of a tripleline processing path. Scottcomments, “We’ve designedthe laboratory around leanflow; we implemented threelinear workflows and competitor
teams. We want to move awayfrom “urgent” samples to a“first in- first out” method.
It’s common sense. If anurgent comes in, instantly
you delay everything else.”

For many years, UHW have used Excelsior ES tissue
processors from Epredia on each of the three processing
streams. The oldest processor, still in use, was installedin 2001. They appreciate the benefits of Excelsior and ofbeing able to process in smaller “through the day” cycles.
Speaking favourably of Excelsior, Scott comments, “Excelsior
tissue processors let us use smaller batch sizes and quicker
turnaround times. They also give us ease of maintenance;
the easy reagent change does itself. There is nothing difficult,and there is very limited downtime.” When the time came to
upgrade the ageing ES instruments, Scott had no hesitation
in upgrading to the successor Excelsior AS processors, andthis year they purchased five new Excelsior AS units which are
now in the process of being swapped in.
Discussing the quality of the instruments and service, Scottadvised, “We have replaced all of our tissue processors
with the Excelsior AS, having had such good results using
the Excelsior ES. Nothing has been too much trouble forthe customer service team to sort out and we are looking
forward to a continuing successful relationship with Epredia.”Commenting on the transition over to the new units, Scottsaid, “The transition to Excelsior AS was eventually forced,
because one of the old units had broken and was too
expensive to repair. However, we actually couldn’t haveplanned it better. We usually take our time in transitioning tonew instruments, but the switch was actually seamless. We
just got them straight in. They work very well.”
The Excelsior provides high quality tissue processing, withminimal user interaction. Rapid processing enables multiple
runs per day; while Excelsior’s intelligent reagent management
system monitors alcohol quality and rotates reagents only
when needed. This has been proven to save up to 75% inreagent use1 and associated costs. Furthermore the battery
backup and remote monitoring give peace of mind, while
downdraft ventilation and both potassium permanganate
and charcoal filters provide vital protection from formalin andsolvent vapours for maximum user protection.

The team in Cardiff operate very efficient through the day
processing, carrying out multiple runs using the bank ofExcelsior tissue processors. There is a team of staff on eachof three workflow streams, moving from station to station,
cutting and putting straight into cassettes. As soon as they
complete a full rack of cassettes it will go onto the tissue
processor. This is followed by embedding and then throughto sectioning, primary staining and coverslipping. Each teamsees a batch through to the finish, and this eliminates thesituation of having huge batches of blocks all coming off in
the morning. Scott comments, “The nice thing is that you
also get that natural “competitive” situation but retain the highquality as we have the target re-cut rates. The ultimate aim ismaximum productivity but with minimal re-work.”.

“The ultimate aim is maximum productivity
but with minimal re-work.”
Scott Gable, UHW Cardiff

External quality check on Excelsior AS

The Future in Cardiff

The Excelsior also offers a range of other benefits, including
the dedicated Quality Reporting System (QRS). This is anindependent, external and confidential quality reporting
program offered by Epredia for use in conjunction with theExcelsior tissue processors. Participants receive quarterly
reports on their processing quality and, where necessary
recommendations to improve results. When processing tissue
on the sample processor every day it is possible to miss a
gradual drift in quality, whereas if someone else is analysing
independently, there are comparison checks so any drift isrecognised. Scott comments, “QRS is very beneficial. It’snice that it gives us that consistency check externally which
will help us when we think about our ISO validation andrevalidation of equipment. You’ve got that consistent standard.
It’s helpful, and we’re keen to continue.”

The team at Cardiff are now embarking on a cultural change,
and after carrying out significant workload and capacity
analyses they are now beginning to move towards their vision
for an optimised, lean laboratory. Moving forwards, there areplans to expand to a 6-day week across all specialties to fit
in with the increasing workload. Scott says, “The plan is thatstaff will be there when the work comes off the processor,
ready to section and further progress the samples.” As partof their Lean practices, UHW also utilise process mapping,
improvement boards and a suggestion box. This empowers
the staff, allowing them to share their suggestions on how
they can make improvements. The net result is a committed
and positive team of staff and a very efficient laboratory
workflow. The Excelsior tissue processors continue to play avital role in that efficiency. Importantly, the improvements havealso contributed to a significant reduction in turnaround times
in recent years, from twenty days in 2013 to less than tendays last month. Scott explained the importance of ensuringthat his team understands the key part that their work plays inhelping patients and their diagnoses. As part of their role they
will also attend MDT’s (Multi-disciplinary Team Meetings) andthey frequently have guest speakers in to discuss important
topics. Scott concluded, “There are patients at the end of this,people suffering with anxiety waiting for results. That is what
is important.”
Reference:
1. A breakdown of costs associated with routine tissue processors vs the Shandon™
Excelsior™ ES, Submitted by: Becky DiLallo BS, HT(ASCP), Anatomic Pathology
Manager Forum Health-Trumbull Memorial Hospital, Youngstown-Warren, OH, USA

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