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BPPB vs PBBP? What is the Safest Method to Collect and Label Biopsies and Pap Tests?

January 21, 2014
David C. Hoak, M.D.

David C. Hoak, M.D.

In preparation for patient visits, some offices will pre-label biopsy bottles with the patient’s name and then set those bottles in the treatment room in which the patient will be seen.  When the  practitioner takes the biopsy, the bottle is already labeled.  I call this chain of events: BPPB (Bottle ➭ Patient label  ➭ Patient ➭ Biopsy).

This seems like an efficient procedure; however, if the patient cancels the appointment and those pre-labeled bottles are still in the room, there is a possibility that the second patient’s Pap test or biopsy will be placed in bottles labeled with another patient’s name via BPPB (Bottle ➭ Patient1 label ➭ Patient2 ➭ Biopsy2).

If the patient’s biopsy or pap test is mislabeled with another patient’s name and is sent to the laboratory, then what happens?  The laboratory has no way of knowing that the specimen was mislabeled.  The laboratory will accession the specimen under Patient1’s name, test the specimen and issue a final report under Patient1’s name.  When the office receives the findings on Patient1’s sample, hopefully they will realize that Patient1 in fact canceled her appointment, and the pathology report is most likely on Patient2.

The office should then notify the laboratory of the error.  The laboratory cannot just re-assign Patient1’s pathology report to Patient2, because at this point, there is no way to verify the result is for Patient2.  Even if the office were to insist that the report could only be for Patient2, the laboratory is prevented reassigning the report by federal regulations.

The laboratory will fax a form to the office to confirm that the pathology report is not Patient1’s.  Patient1’s pathology report is then amended to say that it does not belong to Patient1.  The laboratory must cancel any charges to Patient1 or refund Patient1 in the event this problem was not caught prior to billing and subsequent payment.  Patient2 will most likely be called back to be re-biopsied or re-pap tested.


The safer and preferred method is PBBP (Patient ➭ Biopsy ➭ Bottle ➭ Patient label).  Once the patient is in the treatment room, the biopsy is taken, placed in a bottle and only then is the bottle appropriately labeled with the patient’s name.  While this may not seem as efficient, it is definitely safer for the patient and far outweighs the re-work and anguish that occurs with a mislabeled specimen over the perceived efficiency of pre-labeling specimen bottles before the patient is in the examining room.

Lesson Learned:  PBBP is better, and ultimately more efficient and safer.


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