Large Specimen Surgical Pathology Reporting Facilitated by Lean Workflow and Rapid-Cycle Microwave Processor
Richard J Zarbo, Ruan C Varney, Michael J Dib, Beverly Mahar. Henry Ford Hospital, Detroit, MI
Background: Timeliness of pathology reporting is one of the most common challenges in Surgical Pathology, particularly for large and complex specimens resections requiring more intensive workup for diagnosis. This even more challenging for teaching institutions that integrate residents and education into a large specimen dissection service and can be compounded by Core Histology Laboratory operations that serve as central processing units for numerous remote hospitals.
Design: Pathology workflow in the Henry Ford Hospital Surgical Pathology and Histology Core Laboratory was optimized for continuous flow from work processes of accessioning through gross dissection, histology tissue processing, slide cutting and delivery to pathologists. In this work system, we tested integration of a rapid-cycle microwave processor (Logos, Milestone Medical, Kalamazoo, MI) into continuous flow work for large specimens. The isntrument was initially validated for processing times according to submitted specimen thicknesses from 1-3mm. All specimens were dissected fresh with occurrence of both fixation and processing on the instrument for total processor times ranging from 1.25-3 hours. We then compared surgical pathology report TAT from our previous July 2011 condition of overnight processing of large specimens to the new August 2011 condition of continuous flow processing of larger/complex specimens corresponding to CPT codes 88307 and 88309. Specimen dissection was performed by pathologists' assistants and residents.
Results: 37 large specimen cases (33 coded as 88307 and 4 coded 88309) were dissected fresh at 3mm thickness with formalin fixation and processing in continuous flow on the rapid-cycle processor. TAT from time of accession to case signout was 3.2 days. This is a reduction of 36% from the previously attained TAT of 5 days for both large specimen classes of 88307 and 88309. No histology processing or slide stain quality defects were observed.
Conclusions: Efficient work system designs in surgical pathology and histology can be enhanced with integration of rapid-cycle processors that promote the proven Lean efficiency concept of continuous flow. In teaching institutions, quality and consistency of the work product requires a gross dissection discipline by pathology residents and a different approach that shrinks the non-value added time waste associated with historical overnight or late afternoon batch mode gross dissection.
Category: Quality Assurance
Monday, March 19, 2012 1:00 PM
Platform Session: Section G, Monday Afternoon