[Histonet] tracking turnaround time of intraoperative consultations

[Garrison, Becky]

We have just started tracking from order to sign out for frozen
sections. 

(In addition, frozens are tracked from receipt in pathology to sign out
using the CAP guidelines). 

The trouble with the electronic order (in our institution) is that the
OR may place the pathology order in hospital computer system early in
the surgery so that the order time that prints on the requisition is
substantially different than the actual collect time.

We have resolved this by having the OR staff write the actual collect
time
on the requisition and initial it.  This collect time is also noted in
the OR documentation notes for the surgery.  When OR forgets to note
collect time manually on the requisition (and they do), I call back and
have them  look up and verify the collect time. 

This was started with the cooperation and support of the OR
administration.

For the pathology accession staff, this means they can not use the order
time that crosses the interface to the LIS (lab computer system)  but
must enter the handwritten time as noted on the requisition.  

We have set a goal of 40 minutes from frozen order to sign out. This may
be lowered to 30 - 35 minutes depending on how our data looks over
several months.  Our pathology dept. is located on the first floor and
the OR on second floor of same building.

As for noting collect times for multiple specimens, same case: We have
always required the OR to generate a requisition for each container.
The collect time is written on each requisition.  This is no different
than
writing the collect date/time and initials that nursing/phlebotomy does
for each tube of blood drawn hospitalwide.

Would be interested in hearing from others on how this is handled.

Becky Garrison
Pathology supervisor
Shands Jacksonville
Jacksonville, FL 32209
904-24-6237



-----Original Message-----
From: histonet-bounces <@t> lists.utsouthwestern.edu
[mailto:histonet-bounces <@t> lists.utsouthwestern.edu] On Behalf Of Della
Speranza, Vinnie
Sent: Tuesday, June 23, 2009 4:02 PM
To: histonet
Subject: [Histonet] tracking turnaround time of intraoperative
consultations

CAP utilizes the term "intraoperative consultation" to describe the
utilization of frozen (cryo) sections to provide a rapid diagnosis back
to a surgeon in the operating room.

The CAP checklist requires a turnaround time of 20 minutes for single
specimen submitted for intraoperative consultation. My understanding is
that the turnaround time is measured from the time the sample is
received in the laboratory until the time the report is issued to the
surgeon.

Is anyone tracking or measuring turnaround time from the time the
consult is "ordered" in/by the Operating Room until the time the result
is issued?
If so, would you share how you are able to determine the time the "test
was ordered"  and to what extent you have elicited the cooperation of
Operating Room personnel.

We receive many complex surgical cases and our intraoperative consults
frequently consist of multiple surgical samples from the same patient
arriving in the lab at the same time. Our head and neck cases, for
example, consist of 6-8 biopsies that are sent to pathology at the same
time. In this example, we have no knowledge of which biopsies was
excised first or last and because the surgeon chooses to allow multiple
samples to accumulate before sending them all off to the lab, it's clear
that the true "pre-analytical" time will not be the same for each
sample.

If you are tracking turnaround from the time of order to the time of
result reporting, how are you determining what is an acceptable
turnaround time? CAP's standard is the only national standard I am aware
of for frozen section turnaround times.



Vinnie Della Speranza
Manager for Anatomic Pathology Services
Medical University of South Carolina
165 Ashley Avenue  Suite 309
Charleston, South Carolina 29425
Tel: (843) 792-6353
Fax: (843) 792-8974
 



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