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99 Beauvoir Avenue Summit, NJ 07901 (T) 908-522-2194 (F) 908-522-2320 Histology Workflow Annamarie Dockery Christopher Scano Craig Dise MD Joe Immordino Marilyn Ilvento Michael Overa Nancy Mitchell Ron Delacruz Veronica Fraser Abstract Goals: Decrease the time it takes to process pathology slides Increase our Z score to at least 3.38 Reduce our DPMO to 30,396 Reduce average time to slide availability to 120 minutes from the current 232 minutes Create continuous flow processing Implement rapid tissue processor Reduce overtime Methodologies utilized: Six Sigma Gross dictation to Slide Availability (Pre Improvement) Tally sheet is completed. (This includes any special instructions) PA completes gross dictation in Talk and places specimen into cassette simultaneously Process blocks and slides (enter case # into soft-tells you how many parts it should have) Enter # of levels Enter special stains Cassette is placed in formalin Photocopy daily log book Generate labels Only certain info is rewritten 7:45 am: slides are done staining Slides are placed on the coverslipper (4 minutes for 30 slides) Slides on stainer Slides are placed in a folder. Ready to go to Pathologist Rewrite tally sheet info in a daily log book Places slides into piles Label all slides At OH: all Esoph specimens get a albl stain. Cassette sits in formalin until 4pm 7am: 1st rack of rush slides are placed on staining machine (process takes approx. 38-45 min & can stain up to 6 racks) 7:30am: Janet starts cutting Tissue processor is loaded at 4pm Run controls 5am- processor beeps (complete) 6-6:15am-Starts cutting rushes Processor starts automatically at 5pm 3 a.m.-put tally sheets in order Fill water bath Fill staining machine Processor is drained 5 am: Nancy starts blocking rushes Place racks at embedding centers 7am: Eugenia starts-takes over blocking 5 am: Flo starts blocking UGI(red), LGI(pink), BM(green),Rout(white), Throughout the day, there are also requests for recuts and/or special stains. In order to request one of the above, a form has to be completed. They are then placed in a box. These tasks are performed after semi-rushes. Recuts are only performed if someone is still cutting. Which is usually until 12-1:30. Otherwise, it sits until the next day. Reduced the total number of steps to process slides. (red steps were eliminated) Instead of one batch overnight. Slides are processed continuously throughout the day. Boxplot of Total minutes by phases 350 Problems/Opportunities The single batch overnight process ran approximately 12 hours and did not include the final phase of slide preparation for pathology review Pathologists and physicians are unable to make a diagnosis and treat the patient in a timely manner due to the delays and turn around time of the current process Improve efficiency and increase employee satisfaction Current process and turn around time differs dramatically at the two hospitals. Standardize processes and decrease turn around time Average turn around time was 232 minutes Standard deviation was 44 minutes DPMO was 986,257 Z score was 0 300 250 Total min Introduction Project Objective: To create a continuous flow process to improve overall turn around time, patient care, and physician and patient satisfaction. Racks are removed 200 150 We implemented changes in 2 phases Phase 2 included the addition of the rapid tissue processor Our process capability improved dramatically. We reduced the number of defects by 67% Results/Changes •Adjusted staff schedules •Reallocated tasks •Reorganized tech workflow to accommodate new rapid tissue processor •Reorganized case priority •Utilize partially full racks •Added a third shift •Adjusted Transcription and Pathology Assistant hours •Increased process batches from one to four per day •The overnight run has a larger volume and consists of mostly major •specimens versus biopsies. •Decreased utilization of xylene, alcohol and paraffin •Decrease in Overtime •Decreased turn around time from 232 minutes to an average of 117 minutes. •Since results are available within the same day the specimen is received, •physicians can make same day diagnosis. 100 Baseline PROCESS CAPABILITY PhaseI phases Phase2** Z Score DPMO Defect 0 986,257 98.6% Phase I 0.19 905,136 90.5% Phase II 1.97 318,346 31.8% Before (baseline) Conclusion Staff is empowered Processing time has decreased Increased efficiency Overtime has decreased