Lean Preanalytic Process Improvement of Lymphoma Workup.
Rita D'Angelo, Kedar Inamdar, Ruan Varney, Don Lubensky, Gaurav Sharma, Jason Crane, Jason Pimentel, Oleksandr N Kryvenko, Richard J Zarbo. Henry Ford Health System, Detroit, MI
Background: Lymph nodes biopsied for lymphoma work up may require special handling to be processed promptly for work up with portions of tissue directed to numerous laboratories. To address numerous observed defects in this complex pre-analytic process, we describe a Lean process redesign directed at lymph nodes biopsied via CT guided intervention targeting shorter transport to process times.
Design: The preanalytic process was subjected to value stream mapping to identify steps from specimen collection and preparation, transport to the lab, in-house processing and aliquot delivery to an off-site reference laboratory for flow cytometry testing. Each step in the process was analyzed for time waste, process inefficiencies and further opportunities for improvement. The initial condition was evaluated for lymph node biopsies from Aug-Dec 2009. The post process redesign data was derived from January-September 2010. Measures compared were specimen collection to delivery times and total turn around time from collection to pathology report diagnosis.
Results: To address deficiencies we tested and adopted the following interventions:
1. A visual signal to designate STAT delivery status was created to distinguish these specimens from routine specimens derived from the CT suite. Standard work aides were developed to enable staff to consistently place colored stickers on the specimen, information card, container and bag.
2. A direct connection was established between CT and Pathology to assure ASAP specimen transport from 3 floors away directly to the Surgical Pathology Gross Room, bypassing the Clinical Laboratory.
3. A chain of custody hand-offs was created with time/date of each specimen taken and received. This log is the daily metric assuring processing times are met.
4. Enhanced communication was established between all stakeholders to enable real-time feedback to communicate discrepancies and resolutions.
Our baseline of 20 lymph node biopsies was an average preanalytic specimen collection to laboratory delivery time of 4.23 hours. After process redesign, the timeliness of specimen delivery to lab improved by 33% to 1.38 hours. The total turnaround time from biopsy procedure to pathology report improved by 20% from 5 to 4 days.
Conclusions: Using Lean tools of value stream mapping and Lean work rules targeting creation of standardized work, connections and pathways can result in marked reduction of time waste in the preanalytic aspect of lymphoma work up that may impact downstream specimen integrity with potential diagnostic implications.
Category: Quality Assurance
Monday, February 28, 2011 1:00 PM
Poster Session II # 211, Monday Afternoon