2005

Frozen Section Finesse
August 24, 2005

In our most honest and humorous discussion, each participant shared their experiences with a variety of frozen section situations. Among the topics discussed:

Discouraging the surgeon from requesting frozen sections on pigmented lesions

Handling multiple frozen sections with no help

Interpreting the brain frozen section

Inappropriate or unnecessary frozen sections-such as small GI biopsies.

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Several helpful points emerged:

Obtain all the clinical information on the patient and case (history and physical, radiographs, laboratory data, previous biopsy slides and reports) ahead of time. In several institutions, the secretaries were instructed to print and gather this information on the patients the night or in the morning when the OR schedule is first delivered to pathology.

In anticipated complicated cases with multiple margins (such as skin excisions), discuss with the surgeon how long the case may take and inquire which margin would be most critical. During the frozens, batch your reports, keeping the surgeon abreast of your progress instead of waiting until all of the margins are complete.

Query the surgeon for their impression of the case. This is certainly important with brain frozen sections. Several hospitals have the pathologist speak to the surgeon within the operating suite, facilitating direct communication as well as concurrent review of the radiographs.

The unanimous recommendation-cultivate your relationships with all surgeons. An atmosphere of trust must exist between the pathologist and surgeon before any frozen section may proceed smoothly .

Workflow-Does It?
May 23, 2005

It is a topic which is often taken for granted; how do you organize the workflow at your respective institutions? Dr. Shitabata presented an overview of pertinent issues that need to be addressed by each facility.

Salient points included:

Who is responsible for the daily triage of cases? (histotechs, transcriptionists, pathologists, etc?)  
Are there assigned daily rotations (eg frozen/OR call, clinical, cytology)?  
Is there continuity of cases from the day before (eg if you did the frozen section, you would sign out the complete case the next day)?  
Are cases divided by subspecialty interests?  
Are cases given different weighting (eg, more time given to sign out a bone marrow or radical prostatectomy versus a gallbladder)?  
Are there off-site facilities (eg surgicenters) that must be covered and if so, how are these duties addressed?  
Who does tumor board and specialty conferences?  
Is time given for administrative duties?  
Who attends hospital meetings?  
How is call assigned?  
How are autopsies handled?  
How are cases redistributed or transferred when a pathologist is on vacation?  
How do you orient new pathologists?  
Ways to improve your current system?  

This overview was followed by specific examples of how each group's workflow has evolved to meet the unique needs of each practice setting. The following pathologists provided examples how the workflow issues were addressed by their respective facilities.

Dr. Farahmand-St. Jude Medical Center
Dr. Mendoza-Saddleback Memorial Medical Center
Dr. England-Good Samaritan Medical Center
Dr. Halawa-Little Company of Mary Hospital

It was an interesting and provocative discussion and one that was long overdue.

Productivity and Efficiency Tips
Feburary 28, 2005

We began the new year with a delicate and controversial topic; how does one improve productivity and efficiency? Dr. Shitabata presented a recent article from Harvard Business Review discussing the concept of Attention Deficit Trait-a kissing cousin to the more familiar Attention Deficit Disorder. This recently described syndrome afflicts many adults and is the result of the sensory overload that all of us receive and endure during our normal working day. Dr. Ellis concluded the meeting with a discussion of efficiency tips and the importance of prioritizing activities of the day, both personal and professional.

Last Updated July 31, 2006