Dec 20 2012

Anatomic Pathology’s lean learning path

For a patient anxiously awaiting lab results—the good news, or the bad—time is of the essence. Learning that their tissue specimen was lost would be horrible.

“We aim to put patients first. That’s why we focus on breakdowns in process,” says Jeffrey Myers, M.D., A. James French Professor, and director of the Divisions of Anatomic Pathology and MLabs. AP provides diagnostic and consultative services in the areas of surgical pathology, cytopathology, neuropathology, dermatopathology, and renal and autopsy pathology for U-M and outside health care organizations.

The last time the Division of Anatomic Pathology lost a specimen was 1 year, 25 days ago, and counting. It’s an amazing feat considering that AP processes about 85,000 pathology specimens a year—and that every single one of those specimens goes through 17 separate steps.

Dr. Jeffrey L. Myers, director, Anatomic Pathology and MLabs, and John Perrin, quality assurance coordinator, Department of Pathology, stand in front of the “No Time to Lose” clock outside the Anatomic Pathology and Histology labs in the main hospital. The clock is Myers’ brainchild, and Perrin has the key. Every day, the AP team works to prevent errors—and no one wants to restart the clock.

If you do the math, AP’s current risk of losing a specimen is 2.94 per million opportunities. Their performance surpasses the Six Sigma level, the quality standard of “near perfection.”

They credit their success to a lean journey that began when Myers took the helm in 2006. Myers came to U-M from Mayo Clinic, where he also led lean endeavors.

By 2007, Myers began introducing lean training, lean teams and onsite gemba walks throughout AP that have paid off big by reducing lost specimen errors for weeks, months, years at a time—and by reducing lead times for selected services by 50 percent.

AP’s average turnaround time went from 7 days in 2005 to about 3 days currently.

These improvements occurred while AP’s workload rose 25 percent—from approximately 68,000 specimens in FY2007 to about 85,000 in FY2012.

As a result of lean thinking, AP has:

  • Implemented an operating room (OR) runner to bring specimens to the lab, freeing up OR nurses to spend more time with the patient. For permanent specimens alone, average time of delivery fell from 1 hour, 19 minutes to 7 minutes—an 88 percent decrease.
  • Eliminated the opportunity for specimens to go missing by creating an action plan to limit distractions for lab staff, reorganizing the lab bench to work towards single piece flow, and standardizing workflow.
  • Developed a lost-specimen policy and orienting new residents, pathology assistants, histotechnologists, fellows and faculty.
  • Created an environment in which technicians are encouraged to “stop the line” and ask for help when they are having difficulty with a piece of tissue. Read the rest of this entry »
Dec 17 2012

U-M Health System’s Amy Teddy champions for concussion education

When Michigan’s concussion bill was passed this fall, it was a great day for Michigan; for young athletes, their coaches and parents; and for C.S. Mott Injury Prevention Program Manager Amy Teddy.

The new law requires the Michigan Department of Community Health to develop educational materials and training about concussion-related injuries and treatments for athletes, parents and coaches. It also requires coaches to immediately remove athletes suspected of having concussions from play and let them return only after getting a health professional’s written approval.

Where concussion education is concerned, U-M is already ahead of the game, thanks in no small part to Teddy’s efforts.

Michigan NeuroSport’s concussion education website, which Teddy developed, contains free education modules for parents as well as youth and high school coaches.  Coaches can receive a certificate of completion if they successfully answer the quiz at the end of the module. A student athlete edition is coming soon. The information is endorsed by the American Academy of Neurology.

C.S. Mott Injury Prevention Program Manager Amy Teddy represented U-M by testifying about the need for concussion education and being present at the signing of a new Michigan concussion education law.

Teddy has also been involved in Michigan High School Athletic Association’s decision to have its required online rules meetings for coaches and officials include Michigan NeuroSport’s education module.  The module illustrates the serious nature of concussions; recognition of the signs and symptoms; and a review of return to play protocols.

Further using technology—and supported by a Fostering Innovation Grant (FIGS)—in partnership with NeuroSport, Teddy developed a 99-cent iPhone app called Return 2 Play, which can help athletes through concussion recovery. An Android version of the app will soon be available in 2013 thanks to a second FIGS grant.

“Return2Play helps concussion patients track their activities and symptoms, and share that information with their health care team,” Teddy says. The app is a complement to the online materials and was developed by the same vendor, TorranceLearning of Chelsea, Mich.

Under the direction of a physician, the patient—or a parent or coach—can enter activities, symptoms and their severity, notes, and appointment dates to the app. Return2Play allows users to email a recovery progress history in chronological order to a physician, trainer or coach.

Teddy emphasizes that the app is not a tool for recognizing concussion.

A member of the Mott team for the past five years, she remarks that her work in concussion injury was spurred by one patient in particular.

Spencer inspired me to continue to do more about concussion. He suffered for months, and it was so preventable. His story really highlights the importance of educating those on the front line of youth athletics.”

Teddy invites everyone to download Return2Play, check it out, and post an opinion.

“We’d love to know what’s missing, what’s clunky, what could work better. Anyone who has had some experience with apps could give us the benefit of their knowledge.”

It will cost 99 cents, but to improve concussion recovery education for young athletes, the benefits are priceless.

To read more about Return2Play, visit

Dec 5 2012

A Trip to El Salvador, A Mission of Thanks

Their parents earn as little as $2 a day selling tacos or doing manual labor. They live in one-room homes made of sheet metal, adobe and cardboard. But for seven days in October, these 12 children received the world-class cardiac care they needed—courtesy of a team headed by the University of Michigan Health System. And a cardiac team in El Salvador can now give similar care to the children in their country.

Gabe Owens, M.D., Ph.D., clinical assistant professor, U-M Congenital Heart Center.

This is the second time the UMHS team has traveled to El Salvador as part of an international collaborative sponsored by Gift of Life International (GOLI). After the team’s visit last year, GOLI and Hospital Bloom asked that they return.

This time, the team trained the Salvadoran surgeons to perform more advanced cardiac surgeries on lesions such as tetralogy of Fallot and atrioventricular septal defects (AVSD). They also continued training on the new echocardiogram machine concentrating on transesophageal echocardiography, trained a newly hired perfusionist, enhanced the skills of the ICU nurses and respiratory therapists as they began taking care of more complex patients, and helped improve communication among the entire pediatric cardiac team.

In addition, they provided training in diagnosis, medical management, cardiac anesthesiology, post-operative cardiac care, intensive care nursing, and discharge planning.

“The goal for the entire international collaborative has been to help El Salvador develop its own sustainable pediatric cardiac surgery program,” says team leader Lisa Beckman, BSN, MSMI, Pediatric Cardio-Thoracic ICU (PCTU). Read the rest of this entry »