performing frozen sections

The efficient execution of the frozen section presupposes that each member of the team knows his/her responsibility.  It is possible to perform the actual mechanics of a frozen section in under 10 minutes* if the team is able to work on different aspects of the task simultaneously.  When the histotechnician, resident, and fellow are on site, the following division of labor works best:

As soon as the specimen arrives from the operating room the cutting resident checks to make sure the specimen accompanied by an appropriately filled out sheet is available.  Following this rapid check, the resident hands the specimen to the fellow, but retains the requisition sheet and THREE OPERATIONS ARE SET INTO PLACE NEARLY SIMULTANEOUSLY.

1.    The resident obtains an accession number using the requisition sheet for reference.

2.    The fellow examines the specimen noting pertinent features and selecting the appropriate areas for frozen section.  As soon as the number is available, he/she writes it on the specimen jar.

3.    The histotechnician prepares the chuck for the frozen section.

Following the completion of the frozen section, the fellow and resident review the case and the diagnosis is written down and the initials of the reporting pathologists are included at the end.

The resident or fellow reports the diagnosis verbally to the surgeon.  Always speak in a slow, clear, and confident manner.  The verbal report should in some way identify the operating room to whom they are speaking (i.e. “Hello, Room 2”).  The resident/fellow should indicate it is Pathology calling with the name of the patient, the site of the specimen, and diagnosis.  Make certain before you begin the communication you have all of the information in hand.  ONE DOES NOT SOUND IN CONTROL OF THE SITUATION IF THE INFORMATION IS INCOMPLETE OR ONE STUMBLES OVER PORTIONS OF THE REPORT IN A CONFUSED MANNER.

Special Notes:

1.    It is absolutely imperative that the frozen section diagnosis is written on the requisition or on a page attached to the requisition at the time the diagnosis is rendered.

2.    Kidney stones – kidney stones to be sent out for chemical analysis will be taken to CD directly from Surgical Pathology by one of the technologists, after he/she logs the receipt of the specimen.  No gross description will be done, and no surgical pathology report or charge will be generated.  Results of the chemical analysis will be available on the computer analogous to any other sendout test.

*The CAP recommendation for a frozen section from beginning to end is 15 minutes; the Association Director of Anatomic Pathology estimated that a minimum time for a frozen section performed without other distractions is about 20 minutes.  The difference is accounted for in part by the fact that residents and fellows may be involved in reviewing the case in a sequential fashion.

KJT