5 Strategies to Reduce Sample Processing Turnaround Times

Turnaround time is one of the most closely watched performance indicators in any histopathology laboratory. It measures the interval from the moment a specimen arrives in the laboratory to the point at which a final, authorised report is available to the requesting clinician. When TAT slips, the consequences ripple outward: cancer pathway targets are missed, multidisciplinary team meetings proceed without definitive diagnoses, and patients endure unnecessary anxiety while waiting for results.

The Royal College of Pathologists (RCPath) recommends that 80% of routine histopathology cases should be reported within seven calendar days and 90% within ten. For cancer pathway specimens, the expectations are even tighter, given the 28-day Faster Diagnosis Standard that NHS trusts must meet. Yet many laboratories struggle to achieve these benchmarks consistently, particularly when staffing pressures, rising case volumes, and ageing equipment conspire to create bottlenecks at every stage of the workflow.

The good news is that sustained TAT improvement does not require wholesale transformation. Targeted interventions at specific stages of the laboratory workflow can deliver meaningful, measurable gains. In this article, we examine five practical strategies that laboratory managers and biomedical scientist leads can implement to bring turnaround times under control.

1. Optimise Specimen Reception and Cut-Up Scheduling

The first hours of a specimen's journey through the laboratory are often the most wasteful. Samples arrive in clusters, typically in a mid-morning surge from overnight and early-morning surgical lists. If reception staff and cut-up pathologists operate on a first-come, first-served basis, urgent specimens can sit unprocessed alongside routine biopsies for hours, losing valuable time before they even reach a processor.

A more effective approach involves structured scheduling at the point of reception. This begins with rapid triage: when specimens are accessioned, they should be categorised by urgency and complexity. Urgent cancer pathway cases, frozen sections awaiting intra-operative decisions, and specimens with clinical notes indicating diagnostic urgency should be flagged immediately and routed to the earliest available cut-up session.

Consider restructuring the cut-up timetable itself. Many laboratories run a single large cut-up session each morning, creating a processing bottleneck that cascades through the rest of the day. Splitting this into two or three shorter sessions, staggered across the morning and early afternoon, allows specimens received later in the day to enter the workflow without a 24-hour delay. Some laboratories have achieved significant TAT improvements simply by adding a brief afternoon cut-up session for small biopsies that arrive after the morning deadline.

Batch scheduling is another lever. Rather than processing all specimen types together, grouping similar cases (for example, all GI biopsies or all skin excisions) can accelerate cut-up because the pathologist or BMS performing dissection can work more efficiently when handling a consistent specimen type. This is particularly effective for high-volume biopsy work.

Laboratories that introduce structured triage at reception and staggered cut-up sessions typically see a reduction in the number of cases that exceed their Week 0 processing window.

2. Balance Workload Across Processing Stages

A histopathology specimen passes through a series of discrete stages after cut-up: tissue processing, embedding, microtomy (sectioning), routine H&E staining, and potentially special stains or immunohistochemistry before slides reach a pathologist for reporting. A delay at any single stage creates a queue that propagates downstream, and the overall TAT is ultimately determined by the slowest link in this chain.

The most common bottleneck in many laboratories is sectioning. Skilled microtomists are in short supply, and the work is physically demanding. If embedding runs ahead of sectioning capacity, blocks accumulate and wait. Conversely, if staining instruments sit idle because sectioning cannot keep pace, expensive equipment is underutilised while cases age in the queue.

Effective workload balancing requires visibility. Laboratory managers need to know, at any given moment, how many cases are sitting at each stage: how many are awaiting processing, how many blocks are waiting for embedding, how many are queued for sectioning, and how many stained slides are waiting to be distributed to pathologists. Without this information, resource allocation decisions are made on instinct rather than evidence.

Once you have visibility, you can act. Practical steps include:

• Cross-training staff so that BMSs can move between embedding, sectioning, and staining as demand shifts during the day. A flexible workforce that responds to real-time bottlenecks is far more effective than rigid role assignments.
• Staggering start times for different sections of the laboratory, so that processors finishing an overnight run are met by embedding staff who start early, who in turn produce blocks ready for microtomists arriving at the standard start time.
• Monitoring daily output at each stage and setting internal benchmarks. If your sectioning team typically cuts 300 blocks per day but embedding is producing 400, you have a structural imbalance that will generate a persistent queue.
• Reserving capacity for urgent cases. Dedicating a microtome and a staining slot specifically for urgent and cancer pathway specimens ensures that high-priority work does not compete with routine throughput.

The objective is not to eliminate variation entirely, as that is unrealistic in a biological laboratory, but to prevent chronic imbalances that cause cases to stall at predictable points in the workflow.

3. Implement Real-Time KPI Dashboards

You cannot improve what you cannot see. One of the most impactful changes a laboratory can make is to move from retrospective reporting, where TAT data is reviewed weeks or months after the fact, to real-time operational dashboards that provide immediate visibility into laboratory performance.

An effective dashboard for TAT management should present several key views:

• Cases by stage: A clear breakdown of how many cases are currently at each workflow stage (processing, cut-up, sectioning, staining, immunohistochemistry, reporting). This allows managers to spot emerging bottlenecks before they become critical.
• Cases by age: Grouping active cases by how long they have been in the laboratory is essential. Cases in their first week are on track; cases entering their second or third week require attention; cases beyond four weeks demand immediate investigation. A simple colour-coded view, with cases grouped into bands such as Week 0, Weeks 1-2, Weeks 3-4, and Week 5+, provides an instant picture of workload health.
• Urgent case tracking: A dedicated view for cancer pathway and clinically urgent cases, showing their current stage and elapsed time, ensures that high-priority work never falls through the cracks.
• Cases out of lab: Specimens sent for external review, referral opinions, or additional testing (such as external immunohistochemistry or molecular analysis) need separate tracking. These cases are easy to lose sight of because they leave the physical laboratory, but they still count against TAT targets.

The dashboard should be visible to the entire laboratory team, not locked away in a management reporting tool. Wall-mounted screens in the main laboratory showing current case counts and aged work create a shared awareness that drives collective ownership of TAT performance. When everyone can see that sectioning has a growing queue or that twelve cases have been waiting for consultant sign-off for more than a week, the impetus to act is far stronger than when this information is buried in a monthly spreadsheet.

Weekly TAT reports, generated automatically and distributed to laboratory managers and lead pathologists, provide the medium-term view. These should track the percentage of cases reported within target against the RCPath benchmarks, broken down by specimen type and urgency category. Trend data over weeks and months reveals whether operational changes are having the desired effect or whether further intervention is needed.

4. Streamline Authorisation and Reporting

It is a common frustration in histopathology laboratories that specimens move through the technical stages with reasonable efficiency, only to stall at the final hurdle: consultant authorisation. A case that was processed, cut, stained, and had slides prepared within three days can easily sit in a pathologist's tray for another five or six days, pushing it well beyond target.

The reasons for reporting delays are varied. Pathologists carry heavy workloads and must balance reporting with clinical duties, MDT preparation, teaching, and administrative tasks. Complex cases genuinely require more time for careful assessment. But there are also systemic inefficiencies that can be addressed without asking pathologists to simply work faster.

Structured reporting templates are one such intervention. When pathologists use free-text dictation for every case, reports take longer to compose, longer to transcribe, and longer to verify. Structured, synoptic templates for common specimen types, particularly cancer resections where datasets are well defined (such as the RCPath cancer datasets), reduce the cognitive burden of report composition. The pathologist fills in the required fields, adds free-text commentary where needed, and the report is generated in a consistent, complete format. This approach also reduces the rate of reports returned for amendment due to missing data items, which is itself a significant source of TAT delay.

Batch authorisation workflows offer another improvement for high-volume, routine work. Screening biopsies that show no significant pathology, such as normal colorectal surveillance biopsies or benign skin lesions, can be grouped and reviewed as a batch rather than opened, assessed, reported, and authorised individually. This does not mean reducing the quality of assessment; it means reducing the administrative overhead of signing off each case separately when the clinical context and findings are straightforward.

Finally, consider the physical and digital logistics of slide distribution. If pathologists must collect slides from a central sorting area, cases may sit uncollected for hours. If your LIMS or tracking system can notify a pathologist when their slides are ready and allow them to begin reviewing digital images or preliminary information before collecting physical slides, the idle time between staining completion and reporting commencement is reduced.

5. Monitor, Measure, and Continuously Improve

Sustained TAT improvement is not a one-off project. It requires an ongoing cycle of target-setting, measurement, root cause analysis, and adjustment. Laboratories that achieve lasting improvements treat TAT performance as a continuous quality improvement initiative, not a problem to be solved and forgotten.

The starting point is setting realistic, evidence-based targets. The RCPath guidelines provide a useful framework, but your targets should also account for the specific case mix and complexity of your laboratory. A tertiary referral centre handling a high proportion of complex cancer resections and specialist cases will have a different achievable TAT profile from a district general hospital processing predominantly routine biopsies. Setting unachievable targets demoralises staff and undermines the credibility of the improvement programme.

Once targets are established, every TAT breach should be investigated. Root cause analysis need not be elaborate for every case, but a structured approach helps. Common root causes of TAT breaches include:

• Reception delays: Specimens arriving late from theatres or clinics, or sitting in reception awaiting accessioning.
• Processing failures: Overnight processor breakdowns or overloaded runs that delay embedding the following morning.
• Recuts and deeper levels: Additional sectioning requests that send blocks back through the technical workflow.
• Special stains and immunohistochemistry: Cases requiring additional investigations add days to the workflow, and delays in ordering or performing these tests compound the problem.
• External referrals: Specimens sent for specialist opinion or molecular testing that are not tracked effectively while out of the laboratory.
• Reporting backlogs: Pathologist absence, leave, or subspecialty workload imbalances that create a queue of unreported cases.

Categorising breaches by root cause over time reveals systemic patterns. If 40% of your TAT breaches are attributable to delays in immunohistochemistry, that tells you where to focus improvement efforts. If breaches spike every time a particular consultant is on leave, that points to a workforce resilience issue that needs addressing through cross-cover arrangements.

Regular review meetings, whether weekly huddles or monthly quality meetings, should include TAT data as a standing agenda item. These meetings are most effective when they are attended by both laboratory management and the pathologist team, because many TAT issues span the boundary between technical and medical workflows. A collaborative approach, where BMSs and pathologists jointly own the TAT target, produces better results than one where the laboratory blames the pathologists for slow reporting and the pathologists blame the laboratory for late slide delivery.

The laboratories that consistently meet their TAT targets are not necessarily the best-resourced. They are the ones that measure relentlessly, investigate failures honestly, and make small, sustained adjustments to their workflows.

Conclusion

Reducing turnaround times in histopathology is not about finding a single silver bullet. It requires attention to every stage of the specimen journey, from the moment a pot arrives in reception to the point at which a consultant clicks "authorise" on the final report. The five strategies outlined here, optimising reception and cut-up scheduling, balancing workload across processing stages, implementing real-time dashboards, streamlining authorisation, and committing to continuous measurement, are mutually reinforcing. Each one delivers incremental improvement; together, they create a laboratory culture where TAT performance is visible, owned, and actively managed.

For laboratory managers and BMS leads looking to make a start, the most impactful first step is often the simplest: gain visibility. If you do not currently know how many cases are at each stage of your workflow, or how many have been in the laboratory for more than two weeks, that is the gap to close first. Once you can see the problem clearly, the solutions tend to follow.