[Histonet] Re: tracking turnaround time of intraoperative consultations

[WILLIAM DESALVO]

Vinnie,
I am very interested in this discussion about tracking from time of order to completion. I am particularly interested how or why your institution decided to develop a new tracking parameter that neither CAP or JCAHO require. What drives this decision? What is the specific problem and what changes will you be able to affect once you identify the portion of the process with the most varibility? Most process improvement changes are driven by the voice of the customer. Who is the actual customer in this situation, other than the individual you mention? I would caution you to carefully consider a standard outside of the established regulatory requirements. It is very hard to "go back" to the old practice, once you have new or additional documentation and data.

Without an electronic ordering system and then strict compliance to entering the actual time the specimen was removed, you are only tracking arbitrary information. Without control of the OR process, time entered into a computer, written on a requisition or verbally communicated is only as valid as the reliability of the information or the person entering the information. I do not know how we could arrive at a standard, outside of your institution or any individual institution, because there is to much variability in the pre-processing steps from excision to delivery to the lab. The parameters established in the standard set by CAP, reduces the variables and only tracks the lab processing and review time needed in the lab. Actually the standard is only a trending tool as there is only one type tracked and many exceptions.

Again, I am very interested in the why's and what's associated with developing this process tracking tool. Is it quality improvement, competitive advantage or patient/surgeon request?

William DeSalvo, B.S., HTL(ASCP)
wdesalvo.cac <@t> hotail.com




> From: dellav <@t> musc.edu
> To: rsrichmond <@t> gmail.com; histonet <@t> lists.utsouthwestern.edu
> Date: Wed, 24 Jun 2009 17:14:54 -0400
> Subject: RE: [Histonet] Re: tracking turnaround time of intraoperative	consultations
> CC: 
> 
> Thanks Dr. Richmond. CAP's turnaround time requirement for frozen sections is unchanged.
> 
> My question was prompted by the fact that we have an individual internal to our organization pushing for measuring turnaround from time of order to time result is issued, which muddies the water, at least for us as we do not have electronic ordering from the OR. This is prompted by JCAHO's requirement that turnaround time for critical tests be measured (Frozen section is considered a critical test by this organization)
> 
> As far as I know, there is no national standard to be met if one measures turnaround from time of order, so the data then is up to the institution's interpretation for what is acceptable. 
> 
> One of the respondents indicated that they consider the time the sample gets to pathology as the time the test was ordered. Of those who responded to my query, one lab has electronic order entry and is just beginning to track both the in lab turnaround time and the time from order to result. 
> 
> 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
>  
> 
> -----Original Message-----
> From: histonet-bounces <@t> lists.utsouthwestern.edu [mailto:histonet-bounces <@t> lists.utsouthwestern.edu] On Behalf Of Robert Richmond
> Sent: Wednesday, June 24, 2009 1:29 PM
> To: histonet <@t> lists.utsouthwestern.edu
> Subject: [Histonet] Re: tracking turnaround time of intraoperative consultations
> 
> Vinnie Della Speranza, Manager for Anatomic Pathology Services Medical
> University of South Carolina
> Charleston SC asks about tracking turnaround time of frozen sections (note
> that not every intraoperative consultation requires a frozen section).
> 
> The few services I've worked on that attempted to track turnaround time
> timed them from time of receipt in the laboratory (using a time stamp for
> that) to telephoning the report (the pathologist had to write down the time
> on the hand-scribbled report). The prescribed maximum turnaround was 20
> minutes, which is pretty easy to meet. Cases with multiple frozen sections
> were not timed.
> 
> Has there been some change in the CAP requirements for recording turnaround
> time of frozen sections in the last three years?
> 
> Bob Richmond
> Samurai Pathologist
> Knoxville TN
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