Lean optimization of breast core biopsy process in a core surgical pathology laboratory
Varney RC, Karmo N, Copeland J, and Zarbo R. Lean optimization of breast core biopsy process in a core surgical pathology laboratory. Lab Invest 2018; 98:797.
Background: The Henry Ford Core Surgical Pathology Laboratory receives same-day undissected breast core biopsies transported within a 40-mile radius via multiple couriers from 6 affiliate hospitals and medical center locations with goal of final pathology report in 48 hours of specimen receipt. Due to multiple root causes our breast biopsy turn-around-time (TAT) was in excess of goal resulting in missed tumor board presentations, anxiety for physicians and stress for patients from delays in care management. We challenged our processes to assure a same-day goal to include receipt, tissue examination and histology processing of all breast core biopsies from all sites within the System to provide pathologists with glass slides for interpretation by 8am the next morning. Design: Process redesign was accomplished from March-September 2017 by work teams along the path of workflow empowered to implement changes based on Lean principles and Daily Management board monitoring of metrics of success to include internal process turn-around-times (TAT), specimens not processed within the day, delivery to pathologists and TAT to signout. Results: Redesign improvements focused on visual management to identify the incoming stream of breast core specimens as a priority at receipt and throughout the process. Teams adopted standardized bright pink colored stickers as visual aids at the sending laboratory sites. This continued through surgical accessioning with generation of bright pink cassettes and continued with visual control of specimens delivered to pathologists' assistants who fast-tracked dissected specimens as priority in histology through embedding to microtome to staining to slide delivery to pathologist's desk before 8am the next morning. Histology tissue processor TAT was reduced by 4 hours specimens and specimens that had been received but delayed beyond the next available tissue processor were improved by 86%. TAT from specimen receipt to the glass slide receipt by pathologists improved by 60% (avg. 62 to 24 hrs.). Overall TAT from specimen receipt to pathologist sign out improved by 20% (avg. 41 to 33 hrs.) Conclusions: Visual controls and Daily Management metric boards in accession, gross dissection and histology processing work cells were instrumental in tracking process inefficiencies and focusing teams in testing rapid corrective action to meet daily targets. Improvements were sustained with daily and weekly team huddles for communication of planned changes to accomplish and sustain the goal.