Lean Redesign of Operating Room Specimen Labeling Process
Rita DAngelo, Sue Ruediger, Ruan Varney, Adnan Munkarah, Richard J Zarbo. Henry Ford Hospital, Detroit, MI
Background: Specimen safety results from processes initiated by Surgery and then owned by Pathology. Defects commonly exist in the processes of specimen collection, labeling and hand off from the Operating Room (OR) to the Pathology Laboratory (Lab). Correction of these problems requires aligned standard work and effective communication between both departments.
Design: In an attempt to redesign this process, 3 cross-departmental teams at Henry Ford Hospital, Detroit, consisting of gyn-oncology surgeons, OR nurses, scrub techs, pathologists, and quality staff reviewed surgical processes for specimens from OR to Lab. Teams were charged with identifying and minimizing variation in order to adopt by consensus one pathway to collect, label and deliver Gyn Onc specimens to Lab. Teams directly observed surgeries to observe current OR specimen related processes, then created a value stream map depicting waste, redundancy and potential patient safety issues. Each team met weekly, instructed to develop the “perfect process" that was then presented for team selection of best standardized process. We describe design of a waste-free, error-proof approach to collect and label specimens in absence of computer generated labels.
Results: The most significant patient safety related event was OR handwritten patent labels with specimen identification. A system of handwritten labels without tracking forced nurses to document by hand the same label and container information up to 10 times for each case. For tracking, nurses kept a personal specimen tally then documented this information all over again in the Lab specimen receipt log. As a result of the multi-departmental effort a standardized approach enlisting a direct connection was created between surgeon, scrub nurse, circulator and Lab. To remove redundant handwriting, a specimen labeling packet was innovated that incorporated custom designed carbonless piggy-back labels to document the multiple copies by writing specimen and patient information only once on each lab requisition. Lab requisitions were revised to accept these first-time labels making secondarily written specimen information unnecessary. In this redesign, OR labeling and transfer steps were reduced by 45% (11 reduced to 6 steps). Further upstream, patient information labels generated upon development of patient charts in preparation for surgery, could now be used instead of hand relabeling each specimen.
Conclusions: We have demonstrated the power of multi-disciplinary teams applying Lean at the level of work to focus on patient safety and efficiency by mutually redesigning processes that meet the requirements of both OR and Laboratory.
Category: Quality Assurance
Tuesday, March 5, 2013 9:30 AM
Poster Session III # 258, Tuesday Morning