An Analysis of Amendments of Diagnoses in Surgical Pathology Reports.
Corwyn Rowsell, Michael Sidiropoulos, Mahmoud A Khalifa. Sunnybrook Health Sciences Centre, Toronto, ON, Canada
Background: Amended reports (AmR) are defined as supplemental or secondary reports issued to change original information on a report that has already been issued. Reviewing AmR may be a useful quality assurance tool as they document defects or errors in diagnosis that may have implications for patient safety. We performed a review of our AmR in surgical pathology, focussing on changes in diagnosis/comment with the goal of identifying specific areas for quality improvement.
Design: All AmR over a 27- month period (April 2008 – June 2010) with a change in the final diagnosis and/or comment field of surgical pathology reports were reviewed. Number of amended reports by organ site and day of the week of initial case sign-out were recorded. Other variables investigated included reason for change, as recorded by the pathologist, and type of information changed within the diagnosis/comment field (primary diagnosis, grade, stage, comment, biomarkers, other prognostic factors).
Results: Over the study period, a total of 73, 437 cases were accessioned and 209 AmR for diagnosis/comment were issued (0.28%). AmR occurred most commonly in breast (68; 33% of AmR) and gynecologic (61; 29%) cases, followed by skin (24; 11%), gastrointestinal (20; 10%), genitourinary (19; 9%), and others (17; 8%). For comparison, the percentage of cases accessioned to these groups was as follows: breast 9%; gynecologic 34%; skin 14%; gastrointestinal 21%; genitourinary 6%. No trend was identified with respect to day of the week of initial sign-out. The most common reason given for AmR was typographical error (125; 60%), followed by new macroscopic/microscopic information (37; 18%), immunohistochemical studies (28; 13%), new clinical information (13; 6%), FISH (5; 2%) and EM (1; <1%). The most common components changed were primary diagnosis (109; 52%), comments (40; 19%), staging information (23; 11%), biomarkers (16; 8%), other prognostic factors (13; 6%) and grade (8; 4%).
Conclusions: Our review enabled us to identify areas with a disproportionate amount of amended reports compared to case volume. In a subspecialized practice like ours, this may be helpful in targeting quality assurance initiatives. Although "typographical error" was the most common reason for amendment given by pathologists, local quality improvement guidelines need to emphasize that pathologists are ultimately responsible for the content of the final report regardless of how the diagnosis is entered or by whom.
Category: Quality Assurance
Monday, February 28, 2011 1:00 PM
Poster Session II # 215, Monday Afternoon