Tracking Pathology Report Addenda as Part of a Quality Assurance Process
A Finkelstein, G Levy, N Buza, P Cohen, V Parkash. Yale University, New Haven, CT
Background: Most institutions track amended reports as a part of quality improvement programs. Amendments are defined as changes to information that occur after release of pathology reports. Amendments often possess a certain stigma of an error that has occurred during the diagnostic process. This prompts a trend among many pathologists to issue addenda to final pathology reports if the information added to the report doesn't seem to be changing the nature of the diagnosis. This study aims to investigate the type and impact of information reported in addenda.
Design: We obtained all reports with addenda in the Department of Pathology database for a one month period in 2008. The addenda were reviewed by a panel of three pathologists to estimate the impact of the information contained within the addenda on the final diagnosis and whether this information should be tracked by quality improvement programs.
Results: Of 2,435 retrieved cases, 209 cases had one or more addenda, totaling 338 addenda. Of these 338 addenda, 16 reported information from additional H&E sections and 5 reported missing parts or missing data (organ weights, laterality errors, additional parts, and additional clinical information). Overall, 21 cases (10% of cases with addenda and 0.9% of all reviewed cases) had information within the addenda that had significant diagnostic impact, such as additional sections revealing invasion, critical immunohistochemical stains, and lymph node status.
Conclusions: Analysis of pathology reports with addenda for one month in 2008 revealed the use of addenda to report information that significantly affected either the final diagnosis or potential treatment decisions. The use of an addendum rather than an amended report does not place this information in the optimal formate for retrieval by clinicinas or the electronic medical records. These cases comprised 0.9% of the total number of cases reviewed. This number is comparable with the commonly reported rate of amendments. Therefore: 1) reports with addenda should be periodically reviewed by institutions and tracked along with amendments as one of the quality assurance/quality control (QA/QC) indicators, and 2) the threshold for issuing amended reports may need to be lowered.
Category: Quality Assurance
Tuesday, March 23, 2010 11:15 AM
Platform Session: Section H 2, Tuesday Morning