48 - Precision Under Pressure: Optimizing Specimen Collection During Sinus Sampling

Description: Description of Team:
This quality improvement initiative was led by the perioperative nursing team in collaboration with scrub technologists (CSTs), patient care technicians (PCTs), interventional radiology physicians, and laboratory personnel. The multidisciplinary approach emphasized real-time coordination among surgical, nursing, and lab services to improve diagnostic accuracy during IPSS procedures.
Preparation and Planning:
As a comprehensive cancer center, our institution evaluates patients in whom Cushing's syndrome may be linked to ACTH-secreting tumors, including those associated with malignancy. Inferior Petrosal Sinus Sampling (IPSS) is used to confirm whether ACTH is being secreted by a pituitary source or by an ectopic tumor — directly impacting treatment decisions. Recognizing the complexity and diagnostic significance of this procedure, our team identified the need for standardized workflows, reliable specimen handling, and enhanced interdepartmental communication. Planning included development of educational materials, early lab notification systems, and equipment acquisition.

Assessment:
Through procedural audits and post-case debriefs, the team identified several barriers: inconsistent timing of specimen draws, unclear handoffs between staff, variability in labeling and documentation, and limited awareness among PCT personnel regarding the urgency of IPSS specimens. Additionally, there was no formal workflow or reference guide for perioperative staff, which increased variability and uncertainty, particularly in low-frequency procedures.
Implementation:
The team introduced the following interventions:
- Created a step-by-step IPSS workflow, supported by a PowerPoint training tool and printed binder for RNs, CSTs and PCTs
- Developed visual guides and hands-on orientation for PCTs to support specimen handling and real-time delivery
- Coordinated with the laboratory to:
o Assign a designated contact for each IPSS case
o Ensure pre-labeled, pre-chilled lavender top tubes were available
o Establish day-before alerts to increase lab awareness and readiness
- Purchased a dedicated cooler to maintain proper temperature of specimens throughout the procedure and transport
- Conducted simulation-based training to reinforce timing, documentation, and interdisciplinary communication
Outcome:
- 100% compliance with time-sensitive specimen collection and labeling
- Zero specimen delays or repeat draws following implementation
- Increased confidence among perioperative staff (RN, CST, PCT), as reported through informal post-procedure feedback
- Improved consistency and responsiveness from the lab team
- Higher physician trust in specimen integrity and diagnostic accuracy
Implications for Perioperative Nursing:
This project highlights how perioperative nurses and CSTs can lead and influence diagnostic outcomes through structured planning, interprofessional communication, and process ownership. In high-acuity, low-frequency procedures like IPSS, the precision and readiness of the nursing team directly support patient safety and clinical decision-making. This replicable model demonstrates how standardization and interdisciplinary alignment elevate the role of perioperative nursing in diagnostic excellence — especially within complex oncologic care.