Monthly Gross Room Meeting

Surg Path Meeting 3-1-2019

This month, there will be only five residents on service. Daily bigs will be divided among the non-triage residents and PA student up to a max of 3/day, with surplus beyond this as leftover. Triage resident is recommended to gross simple bigs fresh as allowed by frozen/triage workflow and experience. Additionally, triage resident is strongly recommended to preview OR list.

USCAP grossing coverage has been arranged and will be updated in Amion.

Triage resident protected time from frozens has been confirmed for M-F 8:00am-9:15am, regardless of conference length or cancellation. Between 8:00-9:00, the resident will not be paged regarding frozens. Between 9:00-9:15, residents may begin to receive pages alerting them to presence of frozens, with simple frozens to be covered by the PA, and complex frozens to be handled by the resident (+/- PA/tech assistance) on arrival to the gross room.

Two Grossing QA initiatives have been started. One involves gathering data on the reason for returning to the bucket for a gross specimen, which includes an updated data field on the Pull Specimen form. This information will be discussed over the phone by the tech and resident when requesting a specimen pull, and on completion will be submitted in the designated tray near the formalin baths/triage sheets, or back on the carts. The other involves Rachel pulling one random specimen per week to assess completeness of grossing, gross description, photography, etc.

Weigh all parathyroids fresh (if not recieved from OR in formalin), and to three significant digits (e.g., 0.254 g) --> for now, the scale at the Tissue Bank station may be the best option. In general, please ensure accurate, precise measurements and weights for all specimens.

Scanning blocks is not optional, as this is a key component of case tracking and quality assurance. We recognize that there can be obstacles to this (poorly printed cassettes, suboptimal scanners, ventana malfuctions). If you have trouble scanning cassettes, please see a PA for tips and/or email Ryan in histology for cassette verification.

Surg Path Meeting 2-1-2019

In continuation of recent changes, residents (and PA students) are responsible for grossing all bigs. On Mon-Thur, one resident helper (typically breast service) will gross routines from 5-7pm, while the triage resident manages frozens and triage. On Mon only, the breast service resident will communicate with the HN/BST service resident to determine who will serve as helper, depending on receipt/sign-out of breast cases that afternoon.

For bigs, a sticker should be placed on the triage sheet and scanned at the photo station (to eliminate typos and photo archiving errors). Extra stickers will be printed up-front to faciliate this.

As a reminder, if a specimen requires a larger container, either A) peel the OR sticker off of the initial container and affix it to the new larger container, or B) keep the original container (with OR sticker) with the new container for the duration of grossing, and then return the specimen to original container.

Another reminder, please fill out all fields on the frozen sheet during a frozen. At time of gross, please dictate all information (as per Grossing Manual), and ask for help with unclear text etc.

Suggestion for residents: Keep track of how many weeks of each subspecialty service you've completed, which you can use to gauge your over-/ under-representation of services and then make future scheduling requests to try to even out your experience.

Surg Path Meeting 11-1-2018

Grossing bone marrow core biopsies will now be under the purview of the PAs and gross room technical staff. If any issues or questions arise, please notify the chief residents, Dr. Cipriani, Charlene, or Rachel.

Residents, in order to help facilitate your microscopic review of frozen section slides, please incorporate gross room technical staff and/or PAs into the frozen section workflow more frequently. As you know, techs can cut tissue already embedded in blocks, and PAs can perform the entire process. Keep this in mind especially when multiple parts from a single case or multiple cases with frozen sections are requested simultaneously. Residents should prioritize microscopic examination of the frozen section with the attending pathologist.