Title: Creation of pathology frozen section laboratory in Mott

1. 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 Title: Creation of pathology frozen section laboratory in Mott Owner: Anatomic Pathology (author Jeffrey L Myers, MD) 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. 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. Analysis/root cause: • Mott hospital specimens scattered across multiple pathology rotations involving multiple different faculty and trainees • no standard process for low volume specimens & communication of results Investigation/current state: • 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) • Recommendations: • A regularly scheduled pediatric pathology rotation that includes participation of designated faculty, residents and fellows • Dedicated space adjacent to Mott hospital ORs to provide opportunities for improved layout and flow • Plan: • A pediatric pathology rotation will be created and staffed weekly by designated AP faculty (owners: Jeff Myers and Robert Ruiz) – April 2008 • Residents and surgical pathology fellows will be scheduled for pediatric pathology rotations (owners: Joe Fantone and Barbara McKenna) – July 2008 • Appropriate educational tools and competency measures will be created for participating faculty and trainees (owner: Robert Ruiz) – July 2008 • Broader faculty participation in support of interdisciplinary conferences (owner: Robert Ruiz and Jeff Myers) – July 2008 • 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 • 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 • Appropriate procedures and processes will be developed for laboratory staffing and specimen transportation (owners: Christine Rigney, Theresa Russell, Craig Newman, Dan Visscher) – July 2008 • 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 • 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 turnaround times for Mott hospital cases (i.e. patients < 18 yrs) reflect an uncontrolled process • Next steps: • approve space and budget • design and implement requisition form • activate “IP” prefix in PathNet