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Continuous Specimen Flow Changes Night Shifts to Day Shifts While Reducing Turn-Around-Time

Clay Cockerell, MD, JD, MDA | Mary deBram-Hart, BS, HT | Erico Von Bueren, PhD, MD, MOR | Brenda Wander | Mark Fussner, BS, CT | Claudio Scancich | Craig Reed | Brand McCarley

Jul 26, 2022

Labatory improvement reduce turnaround time.

To reduce average TAT from 36-42 hours to 24-26 hours, the laboratory was restructured to include, relocation and a new floor plan for linear specimen workflow with a larger workspace. Conventional tissue processors were replaced with continuous flow, rapid tissue processors, cassette batch sizes reduced to an maximum of 32, and fully automated embedding was introduced. Personnel was rescheduled to decrease family unfriendly working hours (3pm-5am) and total hours, while increasing laboratory efficiency.


  • Customized WinSURGE® (Computer Trust Corp) Scanning Records using customized tools in Microsoft ® Excel ® 2013.

  • Floorplans analyzing pathway crossings.

  • Analysis of scheduled personnel shifts, family unfriendly (3pm-5am) schedules, and overtime.

  • Analysis of cassette number reduction by increasing the number of spatially separated cross sectioned ellipse/s in Tissue-Tek® Paraform® Sectionable Cassette Systems (Sakura Finetek, Torrance, CA).

  • Specimens were processed on Tissue-Tek VIP® 5, Tissue-Tek Xpress® x120, and embedded on Tissue-Tek AutoTEC® (Sakura Finetek, Torrance, CA).


The Paraform Sectionable Cassette System allows multiple cross sectioned ellipse/s in one cassette, locking their orientation from grossing to microtomy. Using Paraform Cassettes resulted in less cassettes grossed, processed, embedded, sectioned, and less slides stained and reviewed. Daily volumes decreased from 1,600 to 1,358 (-13%), reducing costs and increasing profitability.


  • The new laboratory set-up reduced overall daily working time for the entire Team from 215.5 hrs. to 136 hrs. (-79.5 hrs./-37%) while reducing the daily family unfriendly time (3pm to 5am) by 61% from 119.5 hrs. to 44 hrs./ 75%.

  • The highest reduction of working and family unfriendly time was achieved in Embedding: -52 hrs./-100%, followed by Microtomy and Grossing. The Grossing and Microtomy Teams assist loading and unloading the Tissue-Tek Xpress x120 and Tissue-Tek AutoTEC, allowing task variety.

  • The 4 stacked graphs on the left show the effect on working hours, the 4 stacked graphs on the right show the effect on family unfriendly hours. Noticeably, cumulative overtime was reduced from an average daily total of 16 hours to 0 hours.

  • Overall, all Teams highly appreciated these changes and do not want to return to the previous set-up.


  • Specimens are oriented at grossing eliminating misorientation with manual embedding.

  • Excisions can have multiple cross sectioned ellipse/s and are correctly oriented at grossing using Paraform Sectionable Cassette System reducing the total number of cassettes generated.

  • Only 2% of the daily volume needs manual embedding due to specialty circumstances.

  • Utilization of the Tissue-Tek Xpress x120 and Tissue-Tek AutoTEC allows 80% of specimens to be ready for microtomy within 7 hours after arrival into the laboratory.

  • Continuous flow, rapid tissue processing means no more large batches, bottlenecks, or waiting time.

  • The Tissue-Tek AutoTEC allowed 6 Histotechnicians to change their hours from night shift to day shift, allowing them to work more employee/family friendly shifts.

  • Better hours and less blocks meant staff are able to perform additional duties allowing variety during the work day.  Designing a laboratory in a new building with a Lean workflow floor plan eliminated retraced steps and excessive walking time.

  • Clients, Pathologists, and employees are happier.


Dr. Clay J. Cockerell is a world-renowned specialist in treating and diagnosing skin disorders and has diagnosed over three million biopsies.

An internationally recognized pioneer in his field and double board-certified in dermatology and dermatopathology, Dr. Cockerell has been practicing medicine since 1986.  He is currently the Founder & President of Cockerell Dermatopathology and the Program Director of the Health Education Services dermatology residency program sponsored by the Lake Granbury Medical Center.  Also, Dr. Cockerell sees patients a few days per month to assist with resident training and to keep his clinicopathological skills sharp.

Dr. Cockerell has held numerous leadership positions within several highly regarded medical associations.  Most notably, he served as the President, Secretary & Treasurer and a member of the Board of Directors of the American Academy of Dermatology, President of the Texas Dermatological Society, and President of the Dallas Dermatological Society.  Also, Dr. Cockerell holds leadership roles as Founder and President of Cockerell Dermatopathology and a former AmeriPath Board of Directors member.

Dr. Cockerell and his wife, Brenda, had a lifelong dream of producing wine and, in 2005, purchased a vineyard in Calistoga, California.  They now produce wine under the Coquerel Family Wine Estates label.  Dr. Cockerel and Brenda have two children, Charles and Lillian, and they have been married for forty-six years.  In addition, Dr. Cockerell and Brenda enjoy traveling, golf, and winter sports.


The Cockerell Dermatopathology story begins with Dr. Clay J. Cockerell's vision to establish a practice whose mission is to treat each specimen as if it came from one of own family members.  Family!  At Cockerell Dermatopathology, every employee is driven by a relentless pursuit of diagnostic excellence.  We specialize in evaluating dermatologic disorders, tackling cases ranging from the routine to the most challenging.

Our practice continuously invests in cutting-edge technologies to best serve each referring clinician and their patients.  These innovations result in higher-quality diagnostic slides, quicker turnaround times for routine cases, and seamless deployment of EMR interfaces.

From an educational perspective, Cockerell Dermatopathology is more than a dermatopathology practice.  We host numerous in-person and internet-based education events and boast a state-of-the-art 14-headed microscope for dermatology resident training sessions.

Our services extend beyond borders, serving hundreds of clinicians in Texas, throughout the United States, and globally.  With a highly accessible team of board-certified dermatopathologists and a dedicated support staff, our vision is simple yet profound.  Family, we treat every specimen as if it were from one of our own family members.

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