An Analysis of Addenda to Pathology Reports
A Finkelstein, G Levy, N Buza, P Cohen, V Parkash. Yale University, New Haven, CT
Background: Surgical pathology reports have to be signed out in a certain number of days from receipt of the specimen. With the advent of new technologies such as immunohistochemistry and molecular techniques, pathologists are able to better characterize lesions and provide valuable information to clinicians; however, these procedures often take several days and can delay reporting. One way to avoid this is to report a diagnosis and then write an addendum upon receipt of additional information from auxiliary studies. We investigate the rate of addenda creation and its dynamics from 1993 to 2008.
Design: We queried the Department of Pathology database for reports with addenda issued in the same month in the years 1993, 1998, 2003, and 2008. The number and types of cases and the number of addenda per case were recorded. The addenda were assigned a category based on their diagnostic and therapeutic significance.
Results: The percentages of cases with addenda in one month in 1993, 1998, 2003 and 2008 were 0.9%, 1.7%, 5% and 8.6%. The percentage of cases with 2, 3, 4 and 5 addenda per case changed from 0% in 1993 to 20%, 9%, 4%, and 1% in 2008. The most common type of case changed from GI in 1993 to breast in 2008. The most common type of addenda in 1993 was electron microscopy, in 1998 was flow for ploidy, and in 2003 and 2008 was prognostic immunohistochemistry. The number of addenda that lead to changes in the diagnosis has increased from 0 in 1993 to 21 in 2008. Summary in tables 1 and 2.
|1 month in||# cases||# cases with addenda||% cases with addenda||Most common type|
|1 month in||IHC diagnostic/prognostic||Molecular||EM||Cytogenetics||Ploidy||Other||Diagnostic changes|