Title: Improving workflow for TS cases in Anatomic Pathology (Author – Jeffrey Myers)

1. Title: Improving workflow for TS cases in Anatomic Pathology (Author – Jeffrey Myers) Analysis/root cause: Background: Transfer cases (TC, TD, TE, TH, TS) are the 3rd largest group of cases (after GA and ID), accounting for 12-14% of total non-cytol “in-house” volume, and frequently pose problems in workflow. They are accessioned in two locations and distributed to subspecialty signouts, Room 1, and individual faculty. Included are complex multi-part cases that cross specialties and disciplines. • Transfer cases are not assigned to specific faculty • Transfer cases are distributed in a highly variable fashion based on organ/tissue type, occasionally without regard to staffing or scheduling • Faculty endorsed policy (AP Faculty meeting 9/10/2007) of “bundling” complex transfer cases with multiple parts and assigning to single faculty member/service based on referring physician. • Faculty endorsed policy (AP Faculty meeting 11/12/2007) for holding only selected TS cases in clearly identified areas of signout rooms, and returning all others immediately after verification the surg path area where they will be held for 30 days. Investigation/current state: • Turnaround time for TS cases has improved since OCT04, with a current average of 2 days. Mean TAT for TD cases is 1.2 days over the same time period. • The same improvement in TAT has not occurred for TC (3.2 days), TE (9.1 days), or TH (4.8 days) cases. • Recommendations: • Implement Blockbusters plan for central accessioning and asset management. • Assign transfer cases to specific faculty at COE driven by web-based schedule. • Develop policies for distribution of TS cases to standard locations designated for fellows and faculty only. • Implement and monitor policies for a) “bundling” complex cases by referring physician, and b) timely return of transfer cases to central holding area. • Transfer cases are not currently assigned to specific faculty members and remain difficult to track. • complex transfer cases with multiple parts are frequently unbundled • TS cases continue to be held in signout rooms and faculty offices after verification • Occasionally transfer cases negatively impact the educational experience in selected rotations (eg GU, Gyn) when only a single trainee is present. • Inconsistent and delayed reporting of results to outside institutions • Inconsistent and delayed return of slides and blocks Plan: Task a group to develop a detailed implementation plan for Recommendations • Goal • Distribute and return transfer cases in standard fashion that meets needs of patients, UMHS providers, and referring institutions/physicians • Improve ability to track TS cases in a timely fashion • Align work and workflow with educational goals of training programs Next steps: Return to AP Laboratory Operations Group May 9, 2008 to further refine problem definition and identify group responsible for developing implementation plan.