Evaluation of Communicating Frozen Section Diagnoses with Surgeons
Somak Roy, Anil V Parwani, Rajiv Dhir, Samuel A Yousem, Susan M Kelly, Liron Pantanowitz. University of Pittsburgh Medical Center, Pittsburgh, PA
Background: Communicating the frozen section (FS) diagnosis to the surgeon is a critical component of the FS process. Unfortunately, this often involves reporting a diagnosis via telephone to operating room (OR) staffs other than the surgeon. This may lead to miscommunication and thereby affect patient care. The aim of this study was to evaluate the accuracy of communicating FS diagnoses during intra-operative consultations at our institution.
Design: A total of 300 consecutive cases, where a FS was performed (9 month in 2009), were retrieved from the anatomic pathology laboratory information system (CoPath, Cerner). Cases were included if there was a corresponding OR note in the electronic medical record which described the surgeon's interpretation of the FS diagnosis. Pre-operative diagnosis, intra-operative question, specimen type, FS diagnosis (called to the OR), surgeon's interpretation, final pathologic diagnosis and patient outcome (per clinical notes) were recorded for all cases. Discrepancies between the FS diagnosis and surgeon's interpretation were recorded as a miscommunication and further classified as major (clinical impact) or minor (no clinical impact).
Results: A variety of specimen types were received for FS requesting a diagnosis (59.3%), margin status (30.6%), both a diagnosis and margins (6.6%), or lymph node status for cancer (3.5%). There were 8 (2.6%) miscommunications, all of minor clinical impact, most (88%) of which had a FS diagnosis that was deferred to permanents. Miscommunications in these cases involved reporting “loaded” neutrophils in bone tissue, deferred grading for a sarcoma, interpretation of margins as “excellent” for urothelial dysplasia at ureteral margins, interpretation of a low grade spindle cell proliferation as an inflammatory lesion by the surgeon, and partial documentation in the OR note of two specimens that were submitted for FS diagnosis. In 6 other cases (2%) FS and final pathologic diagnoses were discrepant; however there was no miscommunication of these FS diagnoses to the OR.
Conclusions: The rate of miscommunicated FS diagnoses to surgeons was low at our institution with no adverse patient outcome. Reporting of FS diagnoses using non-standard terminology and indeterminate diagnoses (ie. deferrals) were the most frequent cause for miscommunication. Miscommunications may be circumvented by maintaining a good working relationship with surgeons, requesting immediate acknowledgement following a verbal FS diagnosis and displaying the FS diagnosis in real-time on a monitor in the OR.
Category: Quality Assurance
Monday, March 19, 2012 1:00 PM
Poster Session II # 247, Monday Afternoon