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Reducing reflex first-line prescriptions in a surgical pathology laboratory: toward sustainable practice with positive economic and clinical effects

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Abstract

In surgical pathology departments, reflex first-line techniques (RFLTs) are aimed at reducing workloads and addressing recent shortages of medical personnel. However, the impacts thereof on economic and diagnostic factors have been poorly addressed. Also, in the era of global warming, environmental considerations are crucial. This study assessed the economic and diagnostic efficacies of routine pathological RFLT and the quality of care and sustainability. Ten RFLTs of the Bordeaux University Hospital pathology department (six special stains, one cytology technique, and three immunohistochemical tests) were studied. First, a retrospective economic analysis evaluated the average cost of these RFLTs per slide and per year. Second, diagnostic relevance was prospectively surveyed. Third, the effects of changes made were analyzed over 2 years. The ten RFLTs were associated with average annual costs of €46,708. Diagnostic relevance analysis indicated that most stains were unnecessary; only 17% were requested as second-line techniques. Elimination of 7/10 tests afforded annual cost savings of €22,522 and reduced the workload by 5568 tests/year, without compromising the workflow or diagnostic quality. Seven of ten RFLTs could be eliminated without compromising diagnostic quality or the workflow. This afforded not only financial benefits but also positive social and environmental impacts. We offer valuable insights into appropriate practices in surgical pathology laboratories. Collaboration between the medical and technical teams was crucial; other healthcare sectors would also benefit from our approach.

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Data Availability

The data that support the findings of this study are available from the corresponding author, R.V., upon reasonable request.

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Acknowledgements

We would like to thank the entire surgical pathology department, the supervisory and administrative staff, and the management of Bordeaux University Hospital, in particular, Clément Castera (accounting) who facilitated the economic study and Marielle Lahiton (logistics) for providing the raw data regarding reagents.

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Author notes

  1. Anne Rullier and Marion Marty contributed equally to this work.

Authors and Affiliations

  1. Pathology Department, Bordeaux University Hospital, Bordeaux, France

    Rémi Vergara, Béatrice Vergier, Brigitte Le Bail, Marie-Laure Négrier-Leibreich, Geneviève Belleannée, Anne Rullier & Marion Marty

  2. Fédération Hospitalière de France, Paris, France

    Rudy Chouvel

  3. BoRdeaux Institute of onCology (BRIC)—UMR 1312 INSERM University of Bordeaux, Bordeaux, France

    Béatrice Vergier & Brigitte Le Bail

Authors
  1. Rémi Vergara
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  2. Rudy Chouvel
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  3. Béatrice Vergier
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  4. Brigitte Le Bail
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  5. Marie-Laure Négrier-Leibreich
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  6. Geneviève Belleannée
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  7. Anne Rullier
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  8. Marion Marty
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Contributions

Remi Vergara wrote this work as part of his publicly defended medical thesis, under the guidance of Marion Marty, who designed the study plan. Anne Rullier largely contributed to the ecological and sustainable development aspects of this work. Genevieve Belleannée and Rudy Chouvel promoted the thesis at the national level in France. Béatrice Vergier and Marie-Laure Martin-Négrier served as members of the thesis jury, with Brigitte Le Bail who provided valuable input and helped it evolve.

Corresponding author

Correspondence to Rémi Vergara.

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Ethics approval

The data used in this article is derived from routine laboratory activities and is entirely anonymous. It reflects the general functioning of the laboratory and does not involve any specific patient information. As such, it does not require individual patient data recording or ethical approval. Our study strictly adheres to ethical standards and data privacy regulations.

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The authors declare no competing interests.

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Short abstract

This study evaluated the economic, diagnostic, and environmental costs incurred by a surgical pathology department of a tertiary hospital. We focused on ten reflex first-line systematic analyses (RFLT), thus special stains and immunostainings, and revealed that the elimination of seven of the ten tests afforded substantial cost savings without compromising diagnostic quality or the workflow, illustrating the feasibility and benefits afforded by appropriate practices in a surgical pathology laboratory.

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Vergara, R., Chouvel, R., Vergier, B. et al. Reducing reflex first-line prescriptions in a surgical pathology laboratory: toward sustainable practice with positive economic and clinical effects. Virchows Arch (2024). https://doi.org/10.1007/s00428-024-03817-5

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  • DOI: https://doi.org/10.1007/s00428-024-03817-5

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