TAT for Pediatric Path IF Cases, JUL-DEC07

Avg=3.83

UCL=8.40

LCL=(0.73)

(4)

1

6

11

16

21

26

07

07

07

07

07

07

07

07

08

08

08

08

08

08

08

08

09

09

09

09

09

10

10

10

10

10

10

10

10

11

11

11

11

11

11

12

12

12

12

12

12

12

12

turnaround times for Mott hospital cases (i.e.

patients < 18 yrs) reflect an uncontrolled process

Title: Creation of pathology frozen section laboratory in MottOwner: Anatomic Pathology (author Jeffrey L Myers, MD)

Background: Currently pathology services for Mott patients are provided at a distance from UH. This results in significant quality shortfalls including lost and delayed specimens, delayed turnaround time for intra-operative consultations, and frequent gaps in communications at operational and faculty levels.

Goal: Decrease reporting delays and defects in specimen identification for Mott pathology specimens. Reduce intra-operative waits & delays for Mott OR patients who might benefit from rapid pathology consultation.

Recommendations:1. A regularly scheduled pediatric pathology rotation that includes participation of

designated faculty, residents and fellows2. Dedicated space adjacent to Mott hospital ORs to provide opportunities for

improved layout and flow

Analysis/root cause:

Investigation/current state:

Next steps:• approve space and budget• design and implement requisition form• activate “IP” prefix in PathNet

Plan:1.A pediatric pathology rotation will be created and staffed weekly by designated

AP faculty (owners: Jeff Myers and Robert Ruiz) – April 20082.Residents and surgical pathology fellows will be scheduled for pediatric

pathology rotations (owners: Joe Fantone and Barbara McKenna) – July 20083.Appropriate educational tools and competency measures will be created for

participating faculty and trainees (owner: Robert Ruiz) – July 20084.Broader faculty participation in support of interdisciplinary conferences (owner:

Robert Ruiz and Jeff Myers) – July 20085.Space will be identified with appropriate adjacencies for receiving and

gross processing of specimens received from Mott hospital ORs, including those received for rapid intra-operative consultation (owners: Women’s Hospital backfill project team) – January 2008

6.Space will be appropriately equipped for gross processing, frozen section diagnosis, and signout of cases assigned to the pediatric pathology rotation (owners: Jeff Myers, Robert Ruiz, Craig Newman, Marty Lawlor) – July 2008

7.Appropriate procedures and processes will be developed for laboratory staffing and specimen transportation (owners: Christine Rigney, Theresa Russell, Craig Newman, Dan Visscher) – July 2008

8.A unique requisition form will be implemented to uniquely identify specimens received from Mott Hospital ORs (owners: Robert Ruiz, Craig Newman, Dan Visscher, Debbie Woodard) – April 2008

9.Specimens received from Mott hospital ORs will be accessioned as “IP” cases and assigned to the pediatric pathology rotation (owners: Kathy Davis, Christine Rigney, John Perrin) – April 2008

Pediatric Pathology Cases, JUL-DEC06

429 374 78 43 42 2 1

44%

83%

91%95%

100% 100% 100%

0

100

200

300

400

500

IF GA IS GU TS GS BE

Prefix (rotation)

# of

Cas

es

0%

20%

40%

60%

80%

100%

• 1,180 cases in 6 months (JUL-DEC 2006) from Mott; estimated annual volume 2,360 cases

• most in “general” pediatric surgical pathology (IF, IS) or GI (GA) pathology signout categories

• multiple “sentinel events” for pathology specimens transported from Mott ORs to UH pathology laboratory

specimen sent from Mott OR for frozen section arrived 45 minutes later from UH OR; how specimen traveled from UH path lab to UH OR and back again remains unknown

resected rhabdomyosarcoma sent fresh for tumor protocol on a Friday afternoon languished in Central Distribution at room temperature until following Monday

liver biopsy intended for “rush” processing on a weekend was discovered 2 days later idling at Mott OR desk

• intra-operative consultations with pathology are rare events, and when requested result in significant delays (e.g. recent request for intra-operative consultation for ciliary motility took approximately 1 hour per op note)

• Mott hospital specimens scattered across multiple pathology rotations involving multiple different faculty and trainees

• no standard process for low volume specimens & communication of results