Pathologists Contribute To Women’s Hospital

Same-day pathology reports are one source of value-added anatomic path services

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CEO SUMMARY: Speedier pathology reports and more active involvement with clinicians are two ways that the 15 pathologists at Pathology Group of the Mid-South help Baptist Memorial Women’s Hospital meet its goals of improved outcomes and a patient-friendly environment. Even with an off-site pathology laboratory, same-day reports for most small needle biopsy reports is the norm.

BEFORE OPENING the Baptist Memorial Women’s Hospital(BMWH) in 2001, administrators set out to excel at meeting healthcare’s three new benchmarks: reducing medical errors, improving healthcare outcomes, and achieving the financial margin necessary to sustain the clinical mission.

The new hospital in Memphis, Tennessee, had an unusual opportunity to get things right because administrators could design protocols and procedures to meet the needs of today’s healthcare system. As that happened, anatomic pathologists at BMWH stepped up and made significant contributions to improving the clinician’s time to diagnose and interacting with clinicians on a regular basis.

What adds interest to the story at Baptist Memorial Women’s Hospital is that it was formed in 2001 as a specialty hospital in response to the trends described in the just-published study on hospital transformation, prepared by McKinsey & Co. and analyzed on pages 9-15 in this DARK REPORT.

That is why pathologists and laboratory administrators will find it instructive to learn how BMWH’s organizational strategies motivated the anatomic pathology (AP) department to shorten turnaround time for reporting results. Also, pathologists and laboratory staff at BMWH have become attuned to “go the extra mile” to provide customized service and clinical support to the hospital’s physicians and patients.

Three Strategies

Seeing that the hospital was: 1) focused on delivery of high-quality patient care; and, 2) organized to give physicians clinical and operational support to achieve those outcomes, the AP department responded with three strategies.

First, pathologists eliminated wasted time during the processing of small needle biopsies to speed up turnaround time. Second, the AP department runs molecular markers daily to provide analysis of the hormone receptors on breast cancer tissue, thus cutting the time needed by physicians to develop targeted treatment plans. Third, pathologists play an active role at the weekly tumor board meeting, when all physicians involved in a breast- cancer patient’s care meet to discuss the most effective treatment plan.

BMWH’s emphasis on patient care and improved clinical outcomes has paid off. In July, Baptist Memorial Women’s Hospital was awarded a national citation of merit from the American Hospital Association and McKesson Corporation.

The citation honors leadership and innovation in quality, safety, and commitment to patient care. The citation recognized BMWH’s achievement in attaining improvement in the Institute of Medicine’s six quality aims: safety, patient-centered care, effectiveness, efficiency, timeliness, and equity.

To contribute to this level of clinical performance, the pathology department organized itself around two strategic business objectives. The first is to continuously shorten processing times, particularly for small needle biopsy specimens, and speed the turnaround time for all AP reports. The second is to encourage anatomic pathologists to be more actively involved with the clinicians, throughout the course of a patient’s treatment, if need be.

Reviewing Slides

To speed the delivery of AP reports, BMWH’s pathology department is now organized to review prepared slides throughout the day. “Each morning, the first thing I do is review the biopsies from the preceding afternoon,” stated Thomas M. Chesney, M.D., Medical Director of Laboratories at BMWH. “By 8:30 a.m., all these specimens will have been processed so I can look at them and then call the radiologist. With pathology and radiology results, attending physicians can call the patient.

“Late every afternoon I get the processed slides from biopsies that were collected in the morning,” explained Chesney. “They will have come over to us at midday for processing. By the end of the day, I am calling physicians with the results.”

Chesney is President of the Pathology Group of the Mid-South, which provides pathology services to the five hospitals in the Baptist Memorial Health Care system. It operates a central processing laboratory within three miles of the Baptist Memorial Women’s Hospital. This off-site laboratory processes the biopsy specimens from BMWH.

Saturday A.M. Processing

“To maintain turnaround time at the end of each week, samples collected on Friday afternoon are processed first thing on Saturday morning,” Chesney said. “We have staff come in so that these women don’t have to wait over the weekend for their results.

“It is unusual for any pathology laboratory to have staff come in on Saturdays,” observed Chesney. “But that is one way we deliver excellent service. After these specimens are processed, a staff member from mammography is always available on Saturday to call the patient with the results.

“Our goal is to report all these biopsy results within a day or a day and a half,” Chesney said. “That means that what is collected yesterday afternoon will be reported out first thing in the morning. Biopsies collected each morning are reported out that afternoon.

“The only way to achieve this is to have the entire team in pathology motivated to do whatever it takes to maintain this level of performance,” Chesney stat- ed. “One major way to shorten the time required to report these cases is to minimize time that is wasted between hand-offs. It requires us to identify waste in the work processes and squeeze it out wherever it is found.

“We have couriers who have specific times to pick up samples at the women’s health center,” he continued. “All the staff at the hospital who harvest and handle the biopsy specimens are acutely aware of what those times are and that they must get them in the right place at the right time,” said Chesney. “Our couriers pick them up and bring them to the laboratory, where accessioning and processing staff are anticipating their arrival.

“This whole process takes the cooperation of all of the technical, clerical, and transport people,” he noted. “They know that it is absolutely imperative to waste no time in the process.

“Next, we go one step further,” Chesney said. “Once we make a cancer diagnosis, physicians want to know about the hormone receptors, including HER2/neu, which is the human epidermal growth factor receptor 2. These two tests are done using immunohistochemical reagents.

“We do these molecular diagnostics five times a week. In fact, I have just signed off on a case at 3:40 in the afternoon that I received early this morning,” he commented. “Once we made the diagnosis, we immediately ordered the special stains needed to evaluate these hormone receptors and now I have the results.

Benefit to Patient And Doc

“This has direct patient impact,” continued Chesney, “because it means that, on the first follow-up when that woman goes back to see her doctor, she will know the diagnosis and the type of tumor. Further, her doctor will know whether it is hormonal receptor positive or HER2/neu positive.

“Because of our relationship with Baptist Memorial Women’s Hospital, we process a significant volume of breast cancer samples,” Chesney said. “But other samples have equally high priority, and our system is organized around the size of the tissue in the biopsy. Small needle biopsy specimens that can be processed in just a few hours, can be expedited this way. Typically these are biopsies involving breast cancer, colon cancer, and gastric cancer. For excision specimens with large volumes of tissue, this system wouldn’t work as effectively.”

THE DARK REPORT observes that the adaptations made by Pathology Group of the Mid-South to meet the clinical and patient-service strategies of this specialty women’s hospital are consistent with how McKinsey & Co. predicts that hospitals must evolve to survive and remain economically viable. In particular, the emphasis on same-day reports for many patients shows how speed-to-reported pathology result is a high-value contribution.

Memphis Path Group Serves Five Hospitals

THERE ARE 15 PATHOLOGISTS and 100 staff members at Pathology Group of the Mid- South, located in Memphis, Tennessee. The pathology group serves the five Memphis- area hospitals for Baptist Memorial Health Care, as well as other hospitals and clients in the greater Memphis region.

“We run the clinical laboratories, do the anatomic pathology services, and operate the blood bank for these facilities,” said Thomas M. Chesney, M.D., Medical Director of Laboratories for Baptist Memorial Hospital—Memphis and President of the Pathology Group of the Mid-South. “There are laboratories in each of the hospitals and we have our own separate tissue processing laboratory about three miles from the women’s hospital.”

Pathology Group of the Mid-South does about 40,000 surgical specimens and 80,000 cytology specimens each year.

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