scholarly journals Surgical Pathology Resident Rotation Restructuring at a Tertiary Care Academic Center

2017 ◽  
Vol 4 ◽  
pp. 237428951773634
Author(s):  
Chelsea R. Mehr ◽  
Amrom E. Obstfeld ◽  
Amanda C. Barrett ◽  
Kathleen T. Montone ◽  
Lauren E. Schwartz
Keyword(s):  
Resident Education ◽  
Tertiary Care ◽  
Turnaround Time ◽  
Surgical Pathology ◽  
Primary Sources ◽  
Road Map ◽  
Academic Center ◽  
Organ Systems ◽  
Before And After ◽  
Time Required

Changes in the field of pathology and resident education necessitate ongoing evaluation of residency training. Evolutionary change is particularly important for surgical pathology rotations, which form the core of anatomic pathology training programs. In the past, we organized this rotation based on subjective insight. When faced with the recent need to restructure the rotation, we strove for a more evidence-based process. Our approach involved 2 primary sources of data. We quantified the number of cases and blocks submitted per case type to estimate workload and surveyed residents about the time required to gross specimens in all organ systems. A multidisciplinary committee including faculty, residents, and staff evaluated the results and used the data to model how various changes to the rotation would affect resident workload, turnaround time, and other variables. Finally, we identified rotation structures that equally distributed work and created a point-based system that capped grossing time for residents of different experience. Following implementation, we retrospectively compared turnaround time and duty hour violations before and after these changes and surveyed residents about their experiences with both systems. We evaluated the accuracy of the point-based system by examining grossing times and comparing them to the assigned point values. We found overall improvement in the rotation following the implementation. As there is essentially no literature on the subject of surgical pathology rotation organization, we hope that our experience will provide a road map to improve pathology resident education at other institutions.

Microwave Histotechnology Vs Conventional Histotechnology: A Review

2013 ◽  
Vol 5 (1) ◽  
pp. 34-39
Author(s):  
M Selvamani ◽  
B S Shruthi ◽  
P Vinodh Kumar
Keyword(s):  
Electromagnetic Wave ◽  
Turnaround Time ◽  
Surgical Pathology ◽  
Maximum Output ◽  
Processing Methods ◽  
Temperature Probe ◽  
Time Required ◽  
Wave Induced

ABSTRACT Turnaround time is an important consideration in surgical pathology. Attempts to shorten the time necessary for making a histopathological slide from the surgical tissue has been tried in various ways since many decades without compromising the quality of it. One amongst such attempt is the introduction of microwave to the field of his totechnology. Microwaves, a form of electromagnetic wave induced heat when applied in histotechnology, reproducibly yields histolologic material of similar or superior quality to that provided by conventional processing methods making it more popular in the recent years. A laboratory microwave offers features like maximum output of 2000-3000 watts, an in built source of adjustable temperature probe, facility for ventilation of hazardous fumes, but is expensive. Considering the usefulness of microwave in histotechnology by reducing the time required for the diagnosis, replacing the conventional equipments of laboratories to microwave guided ones is a remarkable and an acceptable change.

Breast Imaging Second Opinion Consultation: A Single Institution’s Process of Improvement and Reform

2020 ◽  
Vol 2 (3) ◽  
pp. 232-239
Author(s):  
Luke Freiburg ◽  
Sonya Bhole ◽  
Elona Liko Hazizi ◽  
Sarah M Friedewald
Keyword(s):  
Quality Improvement ◽  
Breast Imaging ◽  
Tertiary Care ◽  
Turnaround Time ◽  
Second Opinion ◽  
Final Report ◽  
Process Data ◽  
Improvement Project ◽  
Report Turnaround Time ◽  
Before And After

Abstract Objective To review a single institution’s second opinion breast imaging process, data tracking, and metrics before and after implementing quality improvement changes and the effect on report turnaround time. Methods This Institutional Review Board approved retrospective quality improvement project was performed at a tertiary-care academic medical center and included patients 18 years or older who submitted their outside facility imaging for reinterpretation (any combination of mammography, breast ultrasonography, and/or magnetic resonance imaging performed within the last six months) with finalized second opinion reports between June 1, 2016, and July 17, 2017. Significant intradepartmental changes were implemented March 2017 with the goal to improve second opinion report turnaround time. Key metrics from 399 studies were analyzed before and after implemented changes. Two-sided Fisher’s exact test was used to assess the significance of results. Results After department interventions, the percentage of outside reports available at the time of surgical consultation improved from 82% (213/259) to 91% (127/140), an 11% improvement (P < 0.05). The average number of days from initial second opinion consultation to the availability of final report improved from 10.2 days to 9 days, a 12% improvement. Prior to the changes, the number of days it took a radiologist to complete a report varied from 1 to 4 days, but afterwards was consistently 1 day or less. Conclusion Implementation of second opinion intradepartmental changes demonstrated a significant improvement in report turnaround time and the number of finalized reports available at the time of surgical consultation. An efficient second opinion process is crucial to a breast imaging center, as it ultimately expedites patient surgical and oncological care.

scholarly journals Optimizing Specimen Distribution for Residency Training in a Subspecialty-Based Surgical Pathology Rotation in a Tertiary-Care Academic Center

2015 ◽  
Vol 144 (suppl 2) ◽  
pp. A102-A102
Author(s):  
Chelsea Mehr ◽  
Amrom Obstfeld ◽  
Virginia Livolsi ◽  
Emma Furth ◽  
Leslie Litzky ◽  
...  
Keyword(s):  
Residency Training ◽  
Tertiary Care ◽  
Surgical Pathology ◽  
Academic Center

The Effect of Rapid Screening for Methicillin-ResistantStaphylococcus aureus(MRSA) on the Identification and Earlier Isolation of MRSA-Positive Patients

2010 ◽  
Vol 31 (4) ◽  
pp. 374-381 ◽  
Author(s):  
Eilish Creamer ◽  
Anthony Dolan ◽  
Orla Sherlock ◽  
Toney Thomas ◽  
John Walsh ◽  
...  
Keyword(s):  
At Risk ◽  
Predictive Value ◽  
Tertiary Care ◽  
Turnaround Time ◽  
Rapid Screening ◽  
Pcr Assay ◽  
Period 2 ◽  
Before And After ◽  
Patients At Risk ◽  
Risk Patients

Objectives.(1) To determine whether rapid screening with polymerase chain reaction (PCR) assays leads to the earlier isolation of patients at risk for methicillin-resistantStaphylococcus aureus(MRSA) colonization, (2) to assess compliance with routine MRSA screening protocols, (3) to confirm the diagnostic accuracy of the Xpert MRSA real-time PCR assay (Cepheid) by comparison with culture, and (4) to compare turnaround times for PCR assay results with those for culture results.Design.Before-and-after study conducted in a 700-bed acute tertiary care referral hospital. Study periods were (1) a 5-week period before PCR testing began, (2) a 10-week period when the PCR assay was used, and (3) a 5-week period after PCR testing was discontinued.Results.Among 489 at-risk patients, MRSA was isolated from 20 (33%) of 60 patients during period 1, 77 (22%) of 349 patients during period 2, and 18 (23%) of 80 patients during period 3. Twenty-two (27%) of 82 at-risk patients were not screened during period 1, compared with 40 (10%) of 389 at-risk patients not screened during period 2 (P< .001). More MRSA-positive patients were preemptively isolated during periods 1 and 3 compared with period 2 (34 [24%] of 140 vs 28 [8%] of 389;P< .001); however, more MRSA-positive patients were isolated after notification of MRSA-positive results during period 2 (47 [13%] of 349) compared with periods 1 and 3 (2 [1%] of 140;P< .001). The sensitivity, specificity, positive predictive value, and negative predictive value of the PCR assay were 95%, 97%, 82%, and 99%, respectively. The mean turnaround time from receipt of specimens in the laboratory to PCR assay result was 2.6 hours.Conclusions.Rapid screening with the Xpert MRSA PCR assay facilitated compliance with screening policies and the earlier isolation of MRSA-positive Patients. Discrepant results confirm that PCR testing should be used as a screening tool rather than as a diagnostic tool.

scholarly journals 659. Evaluation of Four Chromogenic Agars for Urine Culture Including Time and Cost Savings Analysis

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S386-S386
Author(s):  
Eve Capistran ◽  
Simon Lévesque ◽  
Philippe Martin ◽  
Diane Girard ◽  
Marie-Eve Papirakis ◽  
...  
Keyword(s):  
Primary Outcome ◽  
Susceptibility Testing ◽  
Urine Culture ◽  
Tertiary Care ◽  
Cost Savings ◽  
Turnaround Time ◽  
Microbiology Laboratory ◽  
University Center ◽  
And Performance ◽  
Time Required

Abstract Background With a volume of approximately 5000 urine culture specimens per month in our tertiary-care university center hospital’s microbiology laboratory, we wanted to evaluate methods aiming to improve workflow and performance while reducing turnaround time and potentially overall cost. Methods 310 urine culture specimens as well as selected less frequent pathogens (A. urinae - 26 strains, C. urealyticum - 4 strains) were plated on four chromogenic agars in parallel with standard protocol MacConkey (MAC) and blood agar (BA). Chromogenic agars evaluated were: UriSelectTM 4 (Bio-Rad), CHROMID® CPS® Elite (bioMérieux), BrillanceTM UTI ClarityTM agar Biplate (Oxoid) and BDTM CHROMagarTM Orientation (BD). Primary outcome was overall growth performance for frequent pathogens and for gram positives, where chromogenic agars were previously reported to underperform.The number of additional tests needed and the appreciation of different media by laboratory personnel were also assessed. A sub-analysis measured the total time required to plate and to read 50 consecutive specimens comparatively for the 4 chromogenic agars and for MAC/BA. Results Global performance was 90% for Uriselect, 88% for ChromID, 89% for Chromagar and 81% for Brillance compared to 84% for standard method. ChromID and Brillance supported the growth of more A. urinae and C. urealyticum than the other 2 chromogenic agars. All monoplate chromogenic agars were appreciated equally by technologists. In addition, for all chromogenic agars, working time was reduced by half as compared to MAC/BA. We estimated a time economy of approximately 80 hours per month in our laboratory, translating in a net annual economy. Conclusion All 4 chromogenic medias evaluated in our study had an acceptable performance, with specific strengths and weaknesses for each one. The choice of ChromID CPS Elite (bioMérieux) for our center was based on pre-established criteria including performance for more fastidious gram positives, best time and cost economy, and compatibility with current identification method and susceptibility testing platform. However, since the 4 chromogenic agars have been adequately verified in our laboratory, we consider that they could be interchangeable if needed. Disclosures All Authors: No reported disclosures

Voice Recognition Technology Implementation in Surgical Pathology: Advantages and Limitations

2011 ◽  
Vol 135 (11) ◽  
pp. 1476-1481 ◽  
Author(s):  
Meenakshi Singh ◽  
Timothy R. Pal
Keyword(s):  
Technology Implementation ◽  
Resident Education ◽  
Positive Impact ◽  
Voice Recognition ◽  
Turnaround Time ◽  
Error Rates ◽  
Surgical Pathology ◽  
Resident Involvement ◽  
Competency Based ◽  
Average Turnaround Time

Context.—Voice recognition technology (VRT) has been in use for medical transcription outside of laboratories for many years, and in recent years it has evolved to a level where it merits consideration by surgical pathologists. Objective.—To determine the feasibility and impact of making a transition from a transcriptionist-based service to VRT in surgical pathology. Design.—We have evaluated VRT in a phased manner for sign out of general and subspecialty surgical pathology cases after conducting a pilot study. We evaluated the effect on turnaround time, workflow, staffing, typographical error rates, and the overall ability of VRT to be adapted for use in surgical pathology. Results.—The stepwise implementation of VRT has resulted in real-time sign out of cases and improvement in average turnaround time from 4 to 3 days. The percentage of cases signed out in 1 day improved from 22% to 37%. Amendment rates for typographical errors have decreased. Use of templates and synoptic reports has been facilitated. The transcription staff has been reassigned to other duties and is successfully assisting in other areas. Resident involvement and exposure to complete case sign out has been achieved resulting in a positive impact on resident education. Conclusions.—Voice recognition technology allows for a seamless workflow in surgical pathology, with improvements in turnaround time and a positive impact on competency-based resident education. Individual practices may assess the value of VRT and decide to implement it, potentially with gains in many aspects of their practice.

scholarly journals Feasibility of Implementing a Breast Reconstruction Database

2018 ◽  
Vol 27 (1) ◽  
pp. 38-43
Author(s):  
Connor R. McGuire ◽  
Laura Allen ◽  
Martin R. LeBlanc
Keyword(s):  
Breast Reconstruction ◽  
Tertiary Care ◽  
National Database ◽  
Care Hospital ◽  
Database Construction ◽  
Practice Characteristics ◽  
Commitment Cost ◽  
Academic Center ◽  
Time Required ◽  
The Cost

Objective: To assess whether implementing a breast reconstruction database would be feasible in terms of time commitment, cost, and overall benefits in a tertiary-care hospital. Methods: A survey was sent to 40 Canadian plastic surgeons who have a practice focused on breast reconstruction. The survey assessed demographics, practice characteristics, database use, and opinions on database construction. Univariate descriptive analyses were performed on all variables. Results: Thirty-one surgeons responded to the survey (77.5%). Most were from Ontario (29.1%) and worked in an academic center (83.9%). Of all, 45.3% of surgeons performed more than 50 breast reconstructions yearly. Six (19.4%) surgeons utilized databases that were all started for quality improvement and research purposes. Databases included variables such as demographics, type of reconstruction, complications, surgeons involved, and type of implants. Data are input by research assistants (50%) for approximately 4.2 hours per month at a cost below 200$CAD per month. Databases are funded by research grants (50%), hospital funds (33.3%), and/or division funds (16.7%). Of the surgeons without databases, 60% have considered starting a database. Barriers include being too busy (72%) and impressions of the cost being too high (32%). Surgeons commonly felt that a database would be beneficial at their practice (80%), provincially (77.4%), and nationally (67.7%). Conclusions: Plastic surgeons are open to the idea of constructing a breast reconstruction database and that the costs and time required are lower than expected. Grants or integration with existing databases should be pursued on a provincial level first prior to pursuing a national database.

Pilot-scale neutralisation of underground mine water

1996 ◽  
Vol 34 (10) ◽  
pp. 141-149 ◽  
Author(s):  
J. P. Maree ◽  
G. J. van Tonder ◽  
P. Millard ◽  
T. C. Erasmus
Keyword(s):  
Mine Water ◽  
Contact Time ◽  
Pilot Scale ◽  
Underground Water ◽  
Underground Mine ◽  
Economic Feasibility ◽  
Fluidised Bed ◽  
Chemical Composition Of Water ◽  
Before And After ◽  
Time Required

Traditionally acid mine water is neutralised with lime (Ca(OH)2). Limestone (CaCO3) is a cheaper alternative for such applications. This paper describes an investigation aimed at demonstrating that underground mine water can be neutralised with limestone in a fluidised-bed. The contact time required between the limestone and the acid water, chemical composition of water before and after treatment, and economic feasibility of the fluidised bed neutralisation process are determined. A pilot plant with a capacity of 10k1/h was operated continuously underground in a gold mine. The underground water could be neutralised effectively using the limestone process. The pH of the water was increased from less than 3 to more than 7, the alkalinity of the treated water was greater than 120 mg/l (as CaCO3) and the contact time required between mine water and limestone was less than 10 min (the exact contact time depends on the limestone surface area). Chemical savings of 56.4% can be achieved compared to neutralisation with lime.

scholarly journals Surgical outcome of primary intradural spinal arachnoid cysts: a series of 10 cases

2021 ◽  
Vol 57 (1) ◽  
Author(s):  
Essam Abdelhameed ◽  
Ahmed Ali Morsy
Keyword(s):  
Tertiary Care ◽  
Outer Wall ◽  
Arachnoid Cysts ◽  
Neurophysiological Monitoring ◽  
Japanese Orthopedic Association ◽  
Common Location ◽  
Before And After ◽  
Microsurgical Resection ◽  
Tertiary Care Centers ◽  
Intradural Arachnoid Cysts

Abstract Background Primary intradural spinal arachnoid cysts are rare pathologies of uncertain etiology and variable presentation from no symptoms to myelopathy or radiculopathy according to cord or root compression. MRI with diffusion and contrast differentiates them from many pathologies. There is a lot of debate regarding when to treat and how to treat such rare pathologies. Objective We present a series of 10 primary intradural arachnoid cysts and evaluate outcome after surgery. Methods This retrospective study includes patients having primary intradural spinal arachnoid cysts operated in two tertiary care centers from October 2012 till October 2019. Symptomatic cysts were subjected to microsurgical resection or outer wall excision and inner wall marsupialization under neurophysiological monitoring. The Japanese Orthopedic Association Score was used for clinical evaluation while MRI with contrast and diffusion was used for radiological evaluation before and after surgery. Results This series included 10 patients, 4 males and 6 females, with mean age of 40 years. Pain was the most common presentation. The most common location was dorsal thoracic region. Total excision was achieved in 2 cases and marsupialization in 8 cases. All symptoms improved either completely or partially after surgery. No neurological deterioration or recurrence was reported during the follow-up period in this series. Conclusion Treatment of symptomatic primary intradural spinal arachnoid cysts should be microsurgical resection, when the cyst is adherent to the cord, microscopic fenestration can be safe and effective.

scholarly journals Impact of legalization of Medical Assistance in Dying on the Use of Palliative Sedation in a Tertiary Care Hospital: A Retrospective Chart Review

2021 ◽  
pp. 104990912110304
Author(s):  
Amy Nolen ◽  
Rawaa Olwi ◽  
Selby Debbie
Keyword(s):  
Palliative Care ◽  
Acute Care ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Palliative Sedation ◽  
Palliative Care Unit ◽  
Care Hospital ◽  
Medical Assistance ◽  
Medical Assistance In Dying ◽  
Before And After

Background: Patients approaching end of life may experience intractable symptoms managed with palliative sedation. The legalization of Medical Assistance in Dying (MAiD) in Canada in 2016 offers a new option for relief of intolerable suffering, and there is limited evidence examining how the use of palliative sedation has evolved with the introduction of MAiD. Objectives: To compare rates of palliative sedation at a tertiary care hospital before and after the legalization of MAiD. Methods: This study is a retrospective chart analysis of all deaths of patients followed by the palliative care consult team in acute care, or admitted to the palliative care unit. We compared the use of palliative sedation during 1-year periods before and after the legalization of MAiD, and screened charts for MAiD requests during the second time period. Results: 4.7% (n = 25) of patients who died in the palliative care unit pre-legalization of MAiD received palliative sedation compared to 14.6% (n = 82) post-MAiD, with no change in acute care. Post-MAiD, 4.1% of deaths were medically-assisted deaths in the palliative care unit (n = 23) and acute care (n = 14). For patients who requested MAiD but instead received palliative sedation, the primary reason was loss of decisional capacity to consent for MAiD. Conclusion: We believe that the mainstream presence of MAiD has resulted in an increased recognition of MAiD and palliative sedation as distinct entities, and rates of palliative sedation increased post-MAiD due to greater awareness about patient choice and increased comfort with end-of-life options.

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