The Clinical Significance of Crohn Disease Activity at Resection Margins

Sasan Setoodeh; Li Liu; Sarag A Boukhar; Amit G Singal; Maria Westerhoff; Akbar K Waljee; Tasneem Ahmed; Purva Gopal

doi:10.5858/arpa.2018-0011-OA

Major features included integral radio-frequency identification labels (radio-frequency identification tags and traditional bar codes in a single printed label) printed by point-of-care printers in collection suites; dispersed radio-frequency identification readers at major transit points; and systems integration of the electronic health record, laboratory information system, and radio-frequency identification tracking system to allow for computerized physician order entry driven label generation, specimen transit time tracking, intervalbased alarms, and automated accessioning. The frequency of specimen loss in anatomic pathology is not known; it is thought to be rare, but estimates in the literature have ranged from 0.002% to 0.1%.1,6 Mislabeling events are far more common and account for most preanalytic errors.1 Root cause analyses of specimen mislabeling and loss events have revealed various sources of error, including mix-ups due to specimen and label batching, failure to label specimens, incorrect (wrong patient) specimen labels, manual data entry errors, and loss during transport from collection site to laboratory.7 Technology has been instrumental in preanalytic error reduction; in particular, computerized provider order entry and specimen bar coding have fostered major decreases in error rates.8,9 Properly implemented computerized provider order entry standardizes ordering processes, eliminates missing order components, and notifies the laboratory to expect a specimen.10 Bar coding of specimens for tracking and identification has most likely been the greatest contributor to decreases in preanalytical error and has also enabled the use of automation in specimen accessioning and processing.11 Yet, despite these successes, specimen identification and tracking errors still occur, and there remains a need for technologic and process solutions to further reduce such errors in pathology practice. Radio-frequency identification (RFID) tags have been proposed as a potential solution for specimen identification and tracking in anatomic and clinical pathology.12-14 Radiofrequency identification tags are small integrated circuits with an antenna.15 Tags are available in active (batterypowered) or passive (deriving energy from the radio signal emitted by the reader) varieties and operate within a series of regulated frequency ranges, from low frequency to microwave (Table 1).12,16,17 Passive RFID tags are powered entirely by the radio-frequency signal emitted by the tag reader, with size and range characteristics determined by the frequency of operation and type of coupling that powers the tag.18 Radio-frequency identification is widely used in sectors such as manufacturing, agriculture, finance, retail, and government.15 To date, RFID has seen some limited adoption in health care for applications that include patient identification and localization, staff identification and localization, pharmaceutical inventory, equipment tracking, and supply chain management.19 Current examples of RFID use in laboratory medicine and pathology include blood product tracking and specimen labeling and tracking; although experiences with RFID tracking in pathology are limited, the reports have been largely positive.16,20,21 In a trial implementation involving a 14-bed bone marrow transplant unit and remote emergency department blood storage unit, the use of RFID technology led to an 83% reduction in process errors and 10% reduction in labor expenses (system payback calculated at 2-5 years) in their transfusion medicine practice.21 Two studies have reported on RFID specimen tracking for anatomic pathology. [...]despite the clear effectiveness of the technology, cost and workflow complexity limited the expansion of the HF RFID program to other specimen collection areas.

The Clinical Significance of Crohn Disease Activity at Resection Margins

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