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The Warwick system of prospective workload allocation in cellular pathology--an aid to subspecialisation: a
R A Carr1, D S A Sanders, O P Stores
1Warwick Hospital, South Warwickshire Hospitals NHS Trust, Warwick, UK. Richard.Carr@swh.nhs.uk
Insights
The Warwick system offers a simpler, prospective method for scoring histopathology and cytopathology specimens, ensuring equitable workload distribution and supporting subspecialization. This contrasts with the Royal College of Pathologists (RCPath) system, which is more complex and retrospective.
Area of Science:
- Medical Pathology
- Laboratory Management
Background:
- The Royal College of Pathologists (RCPath) published guidelines for histopathology and cytopathology department staffing and workload in 2003.
- A scoring system based on specimen specialty and complexity was proposed to assess departmental and individual pathologist workloads.
- A simplified, prospective scoring system was developed at Warwick District General Hospital.
Purpose of the Study:
- To compare the prospective Warwick system with the retrospective RCPath scoring system for workload assessment in a cellular pathology department.
- To evaluate the impact of the Warwick system on workload distribution and support for subspecialization.
Main Methods:
- Pathologists indicated reporting preferences to form specialist teams.
- Workload was allocated prospectively using the Warwick system (based on specimen type and suggested diagnosis).
- Four pathologists recorded their time for cut-up and reporting over one month for comparison.
Main Results:
- The Warwick system ensured equitable work distribution, facilitating specialist reporting.
- The Warwick system showed less variation in reported points per hour (6.3) compared to the RCPath system (11.5).
- Time and motion studies indicated more consistent reporting times with Warwick points per hour.
Conclusions:
- The RCPath scoring system is complex, retrospective, and inconsistent across subspecialties.
- The Warwick system is simpler, prospective, manageable by technical staff, and promotes even daily workload distribution.
- The Warwick system supports subspecialization in small to medium-sized departments with fair workload distribution.
Background:
Guidelines on staffing and workload for histopathology and cytopathology departments was published by the Royal College of Pathologists (RCPath) in July 2003. In this document, a system is provided whereby the workload of a cellular pathology department and individual pathologists can be assessed with a scoring system based on specialty and complexity of the specimens. A similar, but simplified, system of scoring specimens by specialty was developed in the Warwick District General Hospital. The system was based on the specimen type and suggested clinical diagnosis, so that specimens could be allocated prospectively by the laboratory technical staff to even out workload and support subspecialisation in a department staffed by 4.6 whole-time equivalent consultant pathologists.
Methods:
The pathologists were asked to indicate their reporting preferences to determine specialist reporting teams. The workload was allocated according to the "prospective" Warwick system (based on specimen type and suggested clinical diagnosis, not affected by final diagnosis or individual pathologist variation in reference to numbers of blocks, sections and special stains examined) for October 2003. The cumulative Warwick score was compared with the "retrospective" RCPath scoring system for each pathologist and between specialties. Four pathologists recorded their time for cut-up and reporting for the month audited.
Results:
The equitable distribution of work between pathologists was ensured by the Warwick allocation and workload system, hence facilitating specialist reporting. Less variation was observed in points reported per hour by the Warwick system (6.3 (range 5.5-6.9)) than by the RCPath system (11.5 (range 9.3-15)).
Conclusions:
The RCPath system of scoring is inherently complex, is applied retrospectively and is not consistent across subspecialities. The Warwick system is simpler, prospective and can be run by technical staff; it facilitates even workload distribution throughout the day. Subspecialisation within a small-sized or medium-sized department with fair distribution of work between pathologists is also allowed for by this system. Reporting times among pathologists were shown by time and motion studies to be more consistent with Warwick points per hour than with RCPath points per hour.