A quality improvement initiative to standardize the time-out and specimen collection process for skin biopsies.

Document Type

Conference Proceeding

Publication Date


Publication Title

J Am Acad Dermatol


Lost or mislabeled tissue specimens are a common medical error encountered in various fields of medicine. With such high volumes of specimens being obtained and processed in outpatient dermatologic practices, dermatologists commonly face this concern. As a quality improvement initiative at our large tertiary-care outpatient dermatology practice, we looked to investigate and improve upon our current specimen handling practices. Our test of change for our first “Plan Do Study Act” (PDSA) cycle included a newly designed and implemented “biopsy checklist” that would be filled out by our resident physicians and medical assistants collecting a biopsy specimen. This sheet would also be initialed by the patient for their confirmation of its completion. It confirmed that a proper preprocedure time-out was performed, that the specimen jar and collection sheet were appropriately labeled, and that the specimen was confirmed to be in the specimen jar at the completion of the procedure. We collected data from pre- and post-intervention surveys from the resident physicians (after a 3-week implementation period), assessing their compliance with the above procedures before and after implementation of the new biopsy checklist. In the post-intervention survey, we also assessed the providers’ perceived utility of the new biopsy checklist. Seventeen of eighteen residents responded to the pre-intervention survey, and all eighteen residents responded to the post-intervention survey. Based on the survey results, the percent of respondents who performed time-outs at every biopsy increased from 41% to 67%, the percent of those who attained patient confirmation of specimen collection at every biopsy increased from 41% to 89%, and the percent of those who reviewed the accuracy of the biopsy collection slip at every biopsy increased from 24% to 67%. We also found that 72.2% of residents felt the checklist improves patient safety and helps standardize the time-out process, and 77.8% felt it improved the accuracy of specimen collection and that it was a useful tool for their clinic. Despite expected initial challenges that are often encountered with the implementation of any new procedure in a busy outpatient practice, our resident providers felt that the new biopsy checklist is an effective tool that improves patient safety and the quality of care that we deliver, and it has since become a new standard at our practice.





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