1. Continued Improvement of the Rodent Health Identification and Communication Process Center for Comparative Medicine, Massachusetts General Hospital, Charlestown, MA Before Continuous Improvements After Routine Vet rounds ~ 1 x a month, not scheduled in advance Routine Vet rounds weekly, following established schedule Undefined Treatment plan for open (unresolved) cases 30% of cases open ≤12 weeks Vets check all open cases every 2 weeks Max treatment time allowed is 4 weeks Uncertainty regarding RAS role in diagnosing non-routine cases All non-routine cases immediately referred to vets for diagnosis The Improvement Process Verifying the Improvement Discussion Background By embracing the TPS concept of Kaizen (“Continuous Improvement”), we made additional refinements to our process for identification and treatment of laboratory rodent health concerns. Positive results included better communications between animal care and veterinary staff, more prompt investigation of unusual clinical signs and faster resolution of open cases. Additional improvements are being developed to further improve animal welfare. Our centralized animal care program is responsible for daily observation and timely identification of illness and injury in a population of ~90,000 mice. Four years ago, we used Toyota Production System (TPS) lean management tools to develop a faster, less expensive, and more effective approach to identify, report and resolve rodent health problems. Animal care personnel (Research Animal Specialists; RAS), rather that veterinary technicians, were trained and empowered to use a detailed poster to identify common spontaneous illnesses of laboratory rodents, send the pertinent templated e-mail alert directly to the designated research contact and treat or euthanize the affected animal per a plan developed by staff veterinarians. The results of these initial improvements are provided in Table 1. In the spirit of the TPS principle of Continuous Improvement, we sought ways to further enhance our rodent health concern identification and response process. A rodent health communication value stream manager convened meetings with RAS and veterinarians to identify remaining gaps and possible new improvements. We also used semi- annual IACUC inspections and an AAALAC site visit to help evaluate the processes. Our conclusion was that while the animal care staff were sufficiently empowered, participation of the facility veterinarian was inadvertently reduced, leading to unnecessarily prolonged treatments or lapses in resolving clinical cases after they were documented. We addressed this by establishing weekly vet rounds between RAS and veterinarians, who also refined their treatment standards to include routine veterinarian evaluation of active cases on a standard schedule. Additionally, the health concern identification process was outlined in a flow chart (Figure 1) posted in animal rooms next to the health concerns poster (Figure 2) for easy reference. RAS were trained to alert veterinarians when an animal presented with clinical signs not identical to any of those on the poster. Find possible health concern Able to ID Not sure Refer to poster Fill out and Place orange card on cage Enter case into Palm pilot Select and fill out related email template Email facility contacts And PI contacts Able to ID Still not sure or HC not on poster Email vet Vet will ID Health concern Fill out and place orange card on cage For vet to “look at” update orange card Example Process Flow For Health Concern Not Found on Poster: Before Initial Improvements After 50% response rate to health concern emails 90% response rate to health concern emails 4-5 days average email response time ≤1 day average email response time 12 days maximum delay to start of treatment 3 maximum delay to start of treatment Figure 1Figure 2