[Histonet] Re: tracking turnaround time of intraoperativeconsultations

[Garrison, Becky]

Sorry I did not respond yesterday.  The reason we just started measuring
order to sign out for frozens was also prompted by preparation for our
next JCAHO inspection.  However, there is this distinction.  The Joint
Commission does not define a frozen as a critical test.  The designation
of critical test is left up to the individual institution.  However,
once your institution defines the frozen as a critical test, (indicated
somewhere in a policy), you must conform to JCAHO guidelines for
critical tests.
And apparently this is the buzz with JCAHO watchers right now. 

Here we designate the IntraOp consultations for frozens (not gross only
or Touch prep)  and IntraOp PTH (Clinical test) as a critical tests
and have started tracking order to sign out.  Order time is the time the
surgeon indicates 'send this to pathology' not when pathology receives
the specimen.

We are somewhat in uncharted waters as there is no national standard
that defines target time from order to sign out.  We set a 40 minute
time (20-OR to Path and 20-path to completed frozen). I campaigned
against a 30 minute total time (15 each) because we do have some frozens
that do take over 15 minutes and this was an absolute value (unlike the
CAP goal of 90% within 20 minutes).  Our approach is to monitor,
evaluate the data we retrieve.  There will certainly be adjustments made
to target time and how and what we monitor.  

The data collection raises more questions:  how do you come up with
meaningful data for multiple specimens on a single case; multiple
frozens (different patients) received together or before we are finished
with the first patient's frozen).   This is one of those ideas that
sounds good in theory but presents some challenges in execution. But it
is a valid process to monitor as we periodically have surgeons complain
of the time they are 
waiting for frozen results.  This is really a joint quality management
review which involves multiple departments (OR and Pathology) and how we
make it better for the patient.


Becky Garrison
Pathology Supervisor
Shands Jacksonville
Jacksonville, FL  32209
904-244-6237



-----Original Message-----
From: histonet-bounces <@t> lists.utsouthwestern.edu
[mailto:histonet-bounces <@t> lists.utsouthwestern.edu] On Behalf Of Della
Speranza, Vinnie
Sent: Wednesday, June 24, 2009 5:15 PM
To: 'Robert Richmond'; histonet <@t> lists.utsouthwestern.edu
Subject: RE: [Histonet] Re: tracking turnaround time of
intraoperativeconsultations

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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