[1867] 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
1993	1635	14	0.9	GI (6)
1998	2278	39	1.7	Breast (19)
2003	2974	150	5	Neuro (32)
2008	2435	209	8.6	Breast (58)

1 month in	IHC diagnostic/prognostic	Molecular	EM	Cytogenetics	Ploidy	Other	Diagnostic changes
1993	5/0	1	7	0	0	1	0
1998	5/21	5	8	0	26	1	4
2003	40/44	14	25	2	11	83	12
2008	60/69	53	24	10	0	122	21

Conclusions: The number of addenda has increased more than 8 fold since 1993 and the information within addenda has changed from purely diagnostic to prognostic and therapeutic, therefore, signing out an incomplete report and conveying this important data later may be inadequate. We propose that the guidelines for turnaround time be reconsidered or initial results be reported as a preliminary diagnosis, which is made available to clinicians. When auxiliary studies are finished, a completed report incorporating the findings should replace this “preliminary report” as a Final report, in the manner used for reporting autopsies.
Category: Quality Assurance

Monday, March 22, 2010 1:00 PM

Poster Session II # 212, Monday Afternoon