Exemption of surgical specimens from routine submission to the pathology laboratory: A Canadian environmental scan with recommendations

Introduction: It is common practice to send most tissues removed during a surgical procedure to the pathology laboratory. Policies regarding exemption of certain specimens—diverting them directly to disposal or release—vary widely between hospitals, even within Canada. These policies are shaped by legal regulations, local conventions, and evidence of diagnostic value. This last factor, especially relative to environmental and monetary costs, is increasingly shaping decisions. Background: The requirement to submit all tissue specimens is predominantly driven by provincial health ministerial regulations, although these typically have some exemptions. In some places without regulations, exemption lists are a matter of hospital policy, and in others there are no formalized exemption lists at all. We have conducted a survey of previous work on the topic of exemption lists, in addition to a survey of current practice in Canada, with the aim of drafting guidelines and recommendations for the implementation, evaluation, and revision of these lists in the Canadian context. Results: There is general consensus that some routine exemptions are reasonable, and that low diagnostic-yield specimens do not require routine submission to the laboratory; however, items on exemption lists vary widely in the literature and across Canada, We present for discussion the current exemption practices for 8 Canadian jurisdictions (BC, AB, SK, MB, ON, QC, NB, NS). Recommendations: Exemption lists should be guided by general principles and evidence. Nine specific recommendations are made for the review and updating of pathology exemption practices; both costs and diagnostic utility must be considered. Conclusion: The variation in exemption lists suggests that optimization and continuous improvement has so far been aspirational. By choosing wisely, we can reduce environmental impact and costs while still delivering high-quality care.