359
CORRESPONDENCE
Batching: A Dominant
Economic
Factor in Laboratory Management
Laboratorians know the values of
batch and unit analysis; they understand that no batch is pure and without a r g u m e n t to i n c o r p o r a t i o n of
c e r t a i n c l a s s e s of s p e c i m e n s .
Whether a specimen is made part of
a batch or is analyzed singularly is a
daily decision based on experience
and knowledge. We know to arrange
our specimens so that no identical
type of specimen follows a similar
specimen. We know how to split out
complicated specimens from batch
processing for later slower analysis.
We split our batches to match the
o u t p u t m e c h a n i s m s , ie, t r a n s c r i p tionist services. We s c h e d u l e case
interviews with clinicians knowing
the c o m p l e t i o n t i m e of the b a t c h
each day. We provide quality control
of our batches.
The loss of the batching of specimens would remove the most efficient
method of handling some classes of
laboratory workloads. Division of a
batch is not an efficiency b u t is an
inefficiency. The batch is a collection of
work that through a collection of units
bears an order and existence as a unit.
In the laboratory, a common mode of
analysis, ie, diagnostic microscopy, is
the usual reason for the batch.
If critics of batching are concerned
with the economic factoring of the
testing, they must recognize that the
laboratory activities of the past 75
years have always incorporated the
division of work in the laboratory into
testing that can be batched and testing
that is singular.
In addition, critics of batching must
recognize the diversity of values with
each tested unit and within each batch;
the laboratory operative protocol is
built on this experience (practical wisdom) and is not to be discarded without evaluation. Batches incorporate
values that include the accuracy, the
utility, the effect, the contingent liability, the technical complexity, and the
technologic values of the diagnosis.
In the past, the economic resolution
to this s p e c i m e n d i v e r s i t y w a s to
establish an arbitrary fee schedule and
maintain a balance between the least
expensive tests and the most expensive tests with an attempt to offset the
differences in cost. 3 On an operational
level, this allowed those performing
Vol. 109 • No. 3
batch analyses to alternate between
easy tasks and difficult tasks as the
analysis of the batch proceeded. The
effects of this diversity in specimen
type were felt by everyone dealing
with a batch; for histopathology, the
diversity was felt by the pathologist,
the histotechnologist, and the transcriptionist. In this analytical process,
the removal of the u n c o m p l i c a t e d
specimens does not change appreciably the flow of the analysis, because
the easily recognizable specimens
w i t h o u t complicating features are
quickly evaluated, and the screening
process is accomplished while allowing for the recognition of the uncommon outlying pathologic lesion. In the
instance of palatine tonsils, a subject
of recent review, the mechanics of
analysis are p r o v i d e d readily, the
assurance of nonmalignancy is 100%,
and total assurance is given to the
patient, the family, and the surgeon.
Most u n d e r s t a n d that no biologic
p r o c e s s is 100%, a n d so a further
definitive diagnosis of benignancy is
appropriate. Tonsils are a significant
part of the surgical pathology batch.
GILBERT EDWARD CORRIGAN, MD,
PHD
Laboratory, University Medical Center
of Louisiana School of Medicine
Lafayette, Louisiana
REFERENCES
1. Netser, JC, Robinson RA, Smith RJ, et
al. Value-based pathology: a costbenefit analysis of the examination
of routine and nonroutine tonsil and
adenoid specimens. Am J Clin Pathol.
1997;108:158-165.
2. Fechner RE. Value-based surgical
pathology : a valuable concept. Am J
Clin Pathol. 1997;108:123-126.
3. Narvios AB, Alvarez FE, Glassman A,
et al. Assessing the efficiency of
leukoreduction of cellular blood
components: use of a simplified formalin-fixation and batch-counting
method. Am j Clin Pathol.
1997;107:111-113.
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To the Editor—In batching analysis
or unit analysis, there are different
efficiencies. It is a mistake to criticize
one m e t h o d or the o t h e r w i t h o u t
recognition of the positive features of
each method. Yet, the history of laboratory criticism is full of this analytical error. A recent review of the batch
analysis of tonsils for surgical pathology analysis promotes this error 1 ; a
supporting editorial continues and
aggravates it. 2 For those w h o have
not worked in a laboratory devoted
to service work, it is a common error.
Even more difficult is the fact that,
generally, they do not perceive their
own error and believe that they have
found a new efficiency. They do not
understand the concept or value of
batching; most have not worked on a
batch of surgical slides, a batch of
chemistry analyses, a batch of cultures, or a batch of hematology differential counts. Many experienced
l a b o r a t o r i a n s , w o r n d o w n by the
continued increment in laboratory
volume, are numbed and nonreactive
to these "splitters."
It is commonplace to find administrators, management personnel, hired
outside efficiency experts, managed
care personnel, and others outside of
the laboratory field hopping onto the
joyride of batch destruction. My experience has been that no amount of reasoning will aid in their understanding
the batch concept. A laboratorian will,
through experience and understanding of the variability of the patient
sample, defend the batch as a working
analytical method bearing its own efficiencies.