Title Improving workflow for TS cases in Anatomic

Title: Improving workflow for TS cases in Anatomic Pathology (Author – Jeffrey Myers) Background: Transfer cases (TC, TD, TE, TH, TS) are the 3 rd 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. Analysis/root cause: • 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 Prefix/service Trainee shelf in histol Surg path fellow UH Drs. Flint & Myers (web schedule) Drs. Flint or Myers UH Fellow assigned to GICons GI Faculty (GI-Cons rotation) TS – neuropath Med Sci Faculty assigned to Neuro (web schedule) Neuropath faculty TS – thyroid/endocrine UH Dr. Giordano TS – breast UH Trainee shelf in histol BE fellow TS – GU UH Trainee shelf in histol GU fellow/resident TS – Gyn 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 UH TS – GI • Transfer cases are not currently assigned to specific faculty members and remain difficult to track. ü complex transfer cases with multiple parts are frequently unbundled ü 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 Responsible individual TS – lung • Turnaround time for TS cases has improved since OCT 04, 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. Distribution Point TS – Room 1 • 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: Accessioning location UH Trainee shelf in histol Gyn resident/fellow TC UH Signout room Fellow/Faculty assigned to FNA (web schedule) TD Med Sci Faculty assigned to Derm -T (web schedule) Faculty TE UH Dr. Flint Drs. Flint & Elner TH Med Sci Hemepath secretary Fellow/resident Recommendations: 1. Implement Blockbusters plan for central accessioning and asset management. 2. Assign transfer cases to specific faculty at COE driven by web-based schedule. 3. Develop policies for distribution of TS cases to standard locations designated for fellows and faculty only. 4. Implement and monitor policies for a) “bundling” complex cases by referring physician, and b) timely return of transfer cases to central holding area. Plan: Task a group to develop a detailed implementation plan for Recommendations Next steps: Return to AP Laboratory Operations Group May 9, 2008 to further refine problem definition and identify group responsible for developing implementation plan.