Improving the process of ordering outside genomic testing for lung cancer FNA and small biopsy specimens - A multidisciplinary quality improvement project

Brandon Nokes; Coralie Baumann; Kim Magallanez; Rodrigo Cartin-Ceba; Amy Wendel Wendel Spiczka; Atul Malhotra; Longwen Chen

doi:10.25259/Cytojournal_47_2021

Improving the process of ordering outside genomic testing for lung cancer FNA and small biopsy specimens - A multidisciplinary quality improvement project

Cytojournal. 2023 Apr 5:20:8. doi: 10.25259/Cytojournal_47_2021. eCollection 2023.

Authors

Brandon Nokes¹, Coralie Baumann², Kim Magallanez³, Rodrigo Cartin-Ceba², Amy Wendel Wendel Spiczka⁴, Atul Malhotra¹, Longwen Chen⁴

Affiliations

¹ Deparment of Pulmonary, Critical Care, Sleep Medicine, University of California, San Diego, California, United States.
² Department of Pulmonary and Critical Care, Mayo Clinic Arizona, Phoenix, Arizona, United States.
³ Department of Management Engineering and Internal Consulting, Mayo Clinic Arizona, Phoenix, Arizona, United States.
⁴ Department of Management Engineering and Internal Consulting, Division of Anatomic Pathology, Mayo Clinic Arizona, Phoenix, Arizona, United States.

Abstract

Objectives: Lung cancer is an important cause of mortality in the United States. Targeted mutation analysis has the potential to alter mortality in those with non-small-cell lung cancer. As such, the importance of timely tissue turnaround time (TAT) is substantial. We evaluated TAT at Mayo Clinic Arizona and found it to be delayed relative to national standards.

Material and methods: We conducted a series of plan, do, study, and act (PDSA) cycles at a single institution to identify areas for improvement with our lung cancer genomic testing. We assembled a multidisciplinary team and held serial meetings to discuss data from each PDSA cycle.

Results: Using PDSA cycles and multidisciplinary discussions, we were able to identify a number of process limitations slowing TAT. We were then able to generate enhanced and timely communication between providers and pathology, educate and enforce the order/requisition workflow, and establish pathology accessioning with lung cancer specimens top priority.

Conclusion: We were able to generate and implement a standard operating procedure for genomic testing of lung cancer specimens at our institution, thereby reducing tissue TAT.

Keywords: Lung cancer; Multidisciplinary care; Mutation testing; Quality improvement; Tissue turnaround time.