Analysis of Addendum Reports in Anatomic Pathology as a Quality Improvement Initiative
Jesse Babwah, Mahmoud A Khalifa, Corwyn Rowsell. Sunnybrook Health Sciences Centre, Toronto, Canada
Background: An addendum report is commonly defined as a report that provides supplementary information to the original report. On the other hand, an amended report replaces the original report in cases where the initially contained information needs to be significantly changed. There are key differences in how these reports are issued and presented in the electronic record which have implications for patient safety. The purpose of our study was to audit addendum reports and identify opportunities for quality improvement.
Design: All Anatomic Pathology addendum reports in a subspecialized academic department that were issued over a 30 month period were retrieved. These were classified by accession class, pathologist/site group, indication for addendum, and whether or not the addendum constituted a significant change from the original report, suggesting that an amendment may have been more appropriate.
Results: A total of 6992 addendum reports were identified (35 autopsy, 2301 cytology, and 4556 surgical pathology). All autopsy and cytology addenda contained information which was deemed supplemental to the original report without conflicting with it. In surgical pathology, 31 addenda (0.6%) represented either a change in information from the original report or a significant omission. Of these 31 addenda, 7 were deemed to be contradictory to the original diagnosis; 30 contained information that potentially changed patient management and 29 altered prognostic information. Reasons for issuing the addenda included immunohistochemical studies, omitted key information in the original surgical pathology report, findings on deeper H&E sections, findings on decalcified sections, and histochemical special stains. 8 out of the 31 reports were issued by a single pathologist (in a department of 18).
Conclusions: While the vast majority of addendum reports are truly supplemental in nature, there is a subset which contains important information that needs to replace some components of the original surgical pathology report. It is noteworthy that many of these reports were necessary because Pathologists signed out reports before receiving all slides/special stains associated with the case. Educational efforts should focus on 1) reviewing all sections/stains prior to issuing the final report, and 2) defining when an amendment is necessary to provide clarity and ensure patient safety.
Category: Quality Assurance
Monday, March 19, 2012 1:00 PM
Poster Session II # 240, Monday Afternoon