Histopathology turnaround time analysis: identifying bottlenecks and implementing mitigation strategies in a multi-site laboratory

Turnaround time (TAT) is a critical quality metric in histopathology laboratories, directly influencing clinical decision-making and patient outcomes. Despite its importance, the specific workflow stages responsible for TAT prolongation in a laboratory serving multiple hospitals could be better characterized. This study aimed to evaluate histopathology laboratory TAT at Brown University Health-Rhode Island Hospital (BUH-RIH), identify workflow bottlenecks, and propose evidence-based mitigation strategies. A retrospective observational study was conducted using a systematic random sample of 97 cases (556 tissue blocks) from a total of 16,227 blocks received during January 2026. Data were extracted from the COPATH laboratory information management system and specimen logs. TAT was defined as the interval between specimen receipt and final report release, excluding weekends. Descriptive statistical analyses were performed using Microsoft Excel and Tableau. Overall, 87.5% of diagnostic biopsy cases were reported within the laboratory benchmark of ≤2 days, and 81.3% of routine surgical cases met the ≤5-day target. Average TAT was 1.6 days for the overall diagnostic biopsies and 3.3 days for the overall routine surgical specimens. The pathologist sign-out stage was the largest contributor to total TAT (1.7 days). Ancillary testing increased average TAT to 2.4 days for diagnostic biopsies and 5.3 days for routine surgical specimens. Inter-hospital and temporal variations were also observed. While overall TAT performance was satisfactory, sign-out and ancillary testing represent the principal bottlenecks. Structured case allocation, defined sign-out schedules, protocol-based early ordering of spare slides, digital pathology adoption, and optimized staffing are recommended to enhance laboratory efficiency and patient care.