Increasing the Efficiency of Autopsy Reporting

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					             Increasing the Efficiency of Autopsy Reporting
                                                             Joseph R. Siebert, PhD

● Context.—When autopsy reports are delayed, clinicians                    tasks, we improved the mean completion time of autopsy
and families do not receive information in a timely fashion.               reports from 53 days (N     47 cases) to 25 days (N   47
   Objective.—Using lean principles derived from the Toy-                  cases). Previously, 17% of reports were completed by 30
ota Production System, we set out to streamline our au-                    days and 71% by 60 days; in the 15 months following ini-
topsy reporting process.                                                   tiation of the program, 72% of reports were completed by
   Design.—In a formal workshop setting, we identified the                  30 days and 100% by 60 days. A follow-up survey of at-
steps involved in producing an autopsy report, then sought                 tending physicians revealed continuing appreciation for
to eliminate, abbreviate, or reschedule them into a more                   the autopsy and timely communication, with no perceived
efficient format. We established intermediate deadlines for                 diminution in the quality of reports.
each case, taking care to make them visible; we initiated                     Conclusions.—This approach was of great benefit in our
a weekly quality assurance review, giving attention to both                laboratory and may assist others in reducing the turn-
scientific issues and approaching deadlines.                                around time of their autopsy reports. It may also benefit
   Results.—By adopting a more standardized approach,                      other areas of the laboratory.
eliminating redundancy, and improving the visibility of                       (Arch Pathol Lab Med. 2009;133:1932–1937)


L  ike other health care workers, pathologists must assign
     priorities to their daily tasks. It is possible, in doing
this, to give less emphasis to the autopsy—and particu-
                                                                           continuous performance improvement (CPI) team, composed of
                                                                           individuals trained to assist in understanding and streamlining
                                                                           workflow. With the help of the CPI team, we examined our sys-
larly to completion of the autopsy report—than to respon-                  tem of autopsy reporting.
                                                                              We first conducted a baseline audit of reporting (turnaround)
sibilities that are considered more pressing. The delay of
                                                                           times. We then organized a 3-day (8 hours per day) workshop,
autopsy reports can, however, be deleterious in a number                   which included workers from each section of our laboratory, ie,
of ways. Clinicians may not receive postmortem findings                     staff pathologists, a pathology fellow, a histology technologist,
in a timely manner; families, waiting for results, may ex-                 and an administrative secretary. In the workshop, we identified
perience heightened anxiety; guidelines mandated by ac-                    the tasks, transfers of materials, and queues—those times or lo-
crediting agencies, such as the College of American Pa-                    cations when workflow stagnates—involved in the autopsy pro-
thologists (CAP), may not be met.1 Delays in the process                   cess. We examined each step to see if any could be rescheduled,
are also inefficient for the pathologist. Clinical histories,               abbreviated, or eliminated. We then implemented several chang-
reviewed at the time of gross examination, may need to                     es, described below, and conducted a second audit to reexamine
be revisited days or weeks later at sign-out; gross and mi-                the completion times of autopsy reports. Finally, we surveyed
croscopic findings may also need to be reviewed more                        attending clinicians to measure the effect of these changes.
than once. Such processes are wasteful when they need to
be reworked. The Toyota Production System has proved                                                  RESULTS
effective in increasing efficiency in numerous hospital and                    An audit of autopsy reports issued in the 15 months
laboratory settings.2–7 Using the lean principles of this sys-             before our performance review showed that the comple-
tem and
				
DOCUMENT INFO
Description: CONTEXT: -When autopsy reports are delayed, clinicians and families do not receive information in a timely fashion. OBJECTIVE: -Using lean principles derived from the Toyota Production System, we set out to streamline our autopsy reporting process. DESIGN: -In a formal workshop setting, we identified the steps involved in producing an autopsy report, then sought to eliminate, abbreviate, or reschedule them into a more efficient format. We established intermediate deadlines for each case, taking care to make them visible; we initiated a weekly quality assurance review, giving attention to both scientific issues and approaching deadlines. RESULTS: -By adopting a more standardized approach, eliminating redundancy, and improving the visibility of tasks, we improved the mean completion time of autopsy reports from 53 days (N = 47 cases) to 25 days (N = 47 cases). Previously, 17% of reports were completed by 30 days and 71% by 60 days; in the 15 months following initiation of the program, 72% of reports were completed by 30 days and 100% by 60 days. A follow-up survey of attending physicians revealed continuing appreciation for the autopsy and timely communication, with no perceived diminution in the quality of reports. CONCLUSIONS: -This approach was of great benefit in our laboratory and may assist others in reducing the turnaround time of their autopsy reports. It may also benefit other areas of the laboratory.
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