Eliminate the Bottleneck: Staffing Models That Deliver Faster Diagnostics

In surgical pathology, Turnaround Time (TAT) is often the single most critical performance metric, directly impacting patient care, clinician satisfaction, and hospital length-of-stay (LOS). Yet, many labs still try to fix slow TAT with frantic management or expensive software upgrades.

The truth? The bottleneck is usually in your staffing architecture. Below, we analyze three proven lab staffing models that, when combined, allow optimized labs to achieve diagnostic TAT improvements ranging from 18% to 32%, according to performance data from high-volume academic medical centers.

Model 1: The “AP Hospitalist” (The Shield Against Interruption)

The biggest enemy of speed and pathology workflow efficiency is interruption. A sub-specialist pathologist (e.g., a GI specialist) can only maintain peak efficiency when performing “deep work.” Every phone call, every unexpected frozen section request, or every administrative task fractures that focus.

• Concept: Dedicate one pathologist per day (on a rotating schedule) solely to handling all “interruptions” –frozen sections, rapid on-site evaluations (ROSE), urgent clinician calls, and immediate sign-outs.
• The Gain: This “Hospitalist” acts as a shield, protecting the expertise of your sub-specialty sign-out team. The efficacy of the AP Hospitalist model in reducing interruptions and improving service quality has been documented in studies (Archives of Pathology & Laboratory Medicine).
• Clinical Impact: This strategy not only increases efficiency but also helps reduce diagnostic TAT by ensuring the most urgent cases are handled by a dedicated resource.

Model 2: The PA “Top-of-License” Strategy

In many labs, highly trained pathologists still spend valuable time performing complex grossing procedures, a task that consumes crucial hours and does not require a medical degree. This is a severe misallocation of expensive talent.

• The Fix: Implement a “Top-of-License” strategy by hiring certified Pathologists’ Assistants (PAs) to take over virtually all routine and complex grossing, frozen section preparation, and routine autopsy duties.
• The Math & ROI: Time-motion studies show that gross examination of surgical pathology specimens is a significant, non-diagnostic workload, often requiring substantial protected time. A study published in the American Journal of Clinical Pathology measured grossing times across 23,402 specimens and demonstrated that complex specimens can require 15–45 minutes each, creating meaningful drains on pathologist availability when not delegated to PAs.

By shifting routine and complex grossing to a PA, laboratories free pathologists to spend more of their day on high-value diagnostic interpretation, consultations, and case sign-out, fundamentally a top-of-license reallocation of labor that increases the diagnostic throughput of the department.

• Financial Case: Multiple cost analyses have shown that grossing performed by a Pathologists’ Assistant is substantially more cost-effective than grossing performed by a board-certified pathologist. A classic cost-minimization study found that PAs can perform grossing duties at significantly lower labor cost than pathologists, while maintaining quality and improving workflow efficiency.
• The Result: Faster availability of slides and more pathologist time to read them immediately cuts the pre-sign-out bottleneck, directly accelerating TAT.

Model 3: Sub-Specialty Triage (The Intelligent Router)

Random case assignment where a complex lung biopsy might be given to a general pathologist who then needs an internal consult, is a major source of unnecessary delay, wastefully consuming resources.

• Concept: Use a dedicated Lab Coordinator or Pathology Assistant (PA) to triage cases immediately upon accessioning, routing them directly to the appropriate sub-specialist (e.g., GI cases to the GI specialist, GYN cases to the GYN specialist).
• The Gain: This process eliminates the “bounce-back” delay, where a generalist wastes time researching an unfamiliar case only to consult a specialist later, adding 1-2 days to the TAT. Intelligent triage accelerates pathology turnaround time while improving first-read accuracy.
• Implementation: This requires a skilled coordinator who understands both the scheduling demands of the specialists and the complexity of the case accessioning.

The Compound Effect: How Staffing Architecture Hits the 32% Target

Achieving the top end of the 18-32% TAT improvement range requires implementing these models not in isolation, but as a compounding system. The efficiency gained in one area reinforces the efficiency in another.

Compound Effect: Staffing Architecture Hits the 32% Target

Change Implemented: Model 2 (PA Grossing)
Time Saved/Regained: 20% of Pathologist time freed up for diagnosis.
Cumulative TAT Impact: ~17%

Change Implemented: Model 1 (AP Hospitalist)
Time Saved/Regained: Removes major daily interruptions and batching delays.
Cumulative TAT Impact: ~10-15% added

Change Implemented: Model 3 (Triage)
Time Saved/Regained: Eliminates 1-2 day “bounce-back” delays for complex consults.
Cumulative TAT Impact: ~5% added

Change Implemented: Combined Result
Time Saved/Regained: 100% of pathologist time dedicated to high-value diagnosis.
Cumulative TAT Impact: 18% – 32% Reduction

This comprehensive staffing approach is an operational imperative. Faster TAT leads directly to improved hospital metrics, reduced length of stay (LOS) for surgical patients, and higher retention of referring clinicians who value speed and reliable communication.

Audit Your Staffing Model With Nicklas

You cannot fix a staffing problem with software. If you are struggling with missed TAT benchmarks, your solution is not necessarily more staff, but the right architecture.

Investing in a dedicated Pathologists’ Assistant (PA) or structuring an AP Hospitalist rotation is an investment in operational excellence with a clear, measurable ROI that pays for itself in efficiency and reduced hospital penalties. Nicklas Staffing specializes in placing the PAs, Sub-specialist Pathologists, and highly skilled coordinators required to build this high-efficiency system.

Contact Nicklas Laboratory Staffing today to audit your current staffing model and secure the talent that will drive your lab’s journey toward that 32% TAT improvement.