1. Title: Operating Room Runner Project Background: Specimens collected in operating rooms are sent to Pathology for several reasons, frozen section (rapid diagnosis of tumor type or see if a margin is clear), tissue procurement for research and tissue for permanent sections for a complete diagnosis of the body site being operated on. Goal: Zero specimen defects reaching laboratory Decrease delivery time from specimen collection in OR to receipt in laboratory Reduce batch delivery of specimens to laboratory to effect single piece flow Decrease valuable OR RN time spent not in operating room Minimize # of personnel handling specimens from OR to pathology lab Recommendations: A full time position be implemented to fulfill this important service to the Operating Rooms. Day and time for this position would be: Mon, Tue, Wed, Fri 0900-1730, and Thurs 1000-1830. Coverage of lunches, breaks, vacations and unexpected absences to be determined. Analysis/root cause: Data was collected during a 2 week pilot; 1 week without a runner, 1 week with (9.28.09 to 10.2.09); data listed below are the results. Errors during pilot: During week 1, 2 errors reached laboratory, both were unlabelled containers. 5 errors occurred during the 2 nd week, 3 were fixed in the OR at the time of retrieval, 1 was a missed label on req by runner and the 5 th was a RN placing formalin on specimen for fresh processing. Error rate for week 1 was 0.41%, week 2 was 0.19%. Specimen delivery: Specimen collection time was recorded by RNs during pilot to determine time lapse for specimen to reach lab after collection. Week 1 & Week 2 data shown in next column: Investigation/current state: Specimens collected in the OR are labeled, entered into a data collection system and delivered to the Pathology Frozen Section Laboratory just outside the sterile corridor by the circulating nurse or other available OR staff. Upon delivery to the lab, OR staff member must write each specimen into a logbook and do one of the following: 1.If permanent specimen, put formalin in container 2.If for frozen or fresh procurement, must notify lab staff. If formalin is placed on these specimens, they are no longer viable for the surgeon-requested purpose. This task is handled by a different Nurse for every active OR and changes with shifts. Current specimen delivery was monitored for 1 week from 9.21.09 to 9.25.09 with the following average delivery times: frozen, 2 minutes; fresh, 14 minutes; permanent, 79 minutes. Error rate was 0.41%. Batch delivery rate of 3 or more specimens was 30.4% (147 of 484 containers received). Incidents Reported by Nursing Staff: Authors: Jeff Lott and John Perrin Date: 3.9.10 Average Time of Delivery for: Specimen TypeWeek 1Week 2 Frozens00:0200:04 Fresh00:1400:04 Permanent01:1900:07 Batch delivery %: 30.4% for week 1, week 2 was 31.3% However, 14% of batched cases were delivered by nursing staff. Batch delivery rate when runners utilized was 17.3% When batching reduced with runner, specimens available earlier in day delivered earlier in day for faster processing. Reduced batching with runner pick-up results in more specimens delivered earlier, as shown in graph below: OR RN Value Added Time: The amount of time spent in OR by nurses would be greatly increased with a runner while the number of distractions would be decreased. Runner will allow RN more time to spend with patient instead of delivering specimens. Personnel Handling Specimens: Number of personnel handling specimens would decrease with a runner. One person would deliver majority of specimens and follow identical delivery procedure each time, reducing the variation in method of handling cases, and resulting errors. Analysis/root cause (con’t): Specimen and corresponding req were labeled with two different patient names; 1 correct, 1 with label from previous surgery in same OR When nurses leave OR, there is often a need for a countable supply at the field. Without nurse to obtain it, the count for that supply may be inaccurate Numerous specimens bound for Clin Path Labs have been placed in wrong delivery bin, sat for days, and have had to be tossed As RN left to deliver specimen, a STAT call was made to the OR. With RN gone, someone else had to break scrub to answer call Specimen was found in OR 5 at 0300. It had been left overnight Specimen was left in an OR overnight. The circulating RN was batching specimens, and went off shift before delivery. The relief RN did not see the specimen jar, and never delivered it to the lab