Studying Amended Reports: Testing Effects of Time of Sign Out, Resident Involvement, and Specimen Type on Amendments
Osama Alassi, Ruan Varney, Frederick Meier, Richard Zarbo. Henry Ford Health System, Detroit, MI
Background: Amended reports may provide insights into conditions of practice that contribute to errors that lead to amendment.
Design: Among amended reports over 18 months. Amendments that revised primary diagnoses, revised secondary diagnostic information (tumor stage, grade, and margin), corrected patient mis identification (mis-ID) were examined. We also noted whether amendments were due to omitted diagnoses. We excluded amendments due to Mis-IDs undiscoverable at the time of sign-out. The reports were studied for date and time of original case signout, resident involvement and their level of training (junior,1st and 2nd year) and senior (3rd and 4th year) and type of specimens whether it is biopsy or large specimen.
Results: The amendments on 9/64 (14%) of examined reports had been initially misclassified: 8 designated 'diagnosis omitted' proved to be revised primary diagnoses, 1 'revised secondary diagnostic information' proved to be a revised primary diagnosis. After these corrections, among 64 amendments we found 16 primary revised diagnoses, 12 revisions of secondary diagnostic information (6 staging, 3 locations, and 3 laterality). 15 omitted diagnoses, and 15 corrected discoverable Mis-IDs. Almost three quarters [47/64 (73%)] of amendments were signed out in the afternoon, more than a third [23/64 (36%)] after 3:00 PM. Residents were involved in only 9/64 (14%) of amendments; senior residents were involved in 6 of these 9 cases. 13/16 (81%) of primary revised diagnoses were biopsies. More than 9/10 of omitted diagnoses were also biopsy specimens. The 15 discoverable misIDs were all biopsies. 7/12 (58%) of revised secondary information, however, regarded large specimens.
Conclusions: First, [14%] of amendments had been initially misclassified: better education of staff about amendment classification is necessary. Second, although we are working towards a continuous specimen flow, cases for sign-out accumulating in the afternoon; we hypothesize, increases staff fatigue and pressure to finalize biopsies within the expected two-day turnaround time: in the afternoon haste makes waste measured by amendments. Third, resident involvement did not appear to figure in amendments. Fourth, biopsies, in greater volume, nature of biopsy to reach an initial diagnosis, and great similarity from case to case, accounted for most primary diagnoses requiring revision, most of the omitted diagnoses, and most preventable misIDs. large specimens, on the other hand, with more secondary features, required more amendments for secondary diagnostic attributes.
Category: Quality Assurance
Tuesday, March 5, 2013 9:30 AM
Poster Session III # 261, Tuesday Morning