Institutional Consultations for Continuation of Patient Care: An Audit of 4 Years Including 3193 Cases from a Single Institution
Kevin G Neill, Sui Zee, Sonya Hwang, Meenakshi Singh, Carmen Tornos. Stony Brook University Hospital, Stony Brook, NY
Background: Mandatory review of outside diagnostic surgical pathology material is standard institutional policy in the majority of medical centers before starting any kind of therapy. The Association of Directors of Anatomic and Surgical Pathology (ADASP) issued guidelines for “consultations in surgical pathology,” referring to these as “institutional consultations” to distinguish them from “personal consultations”. ADASP guidelines state that newly issued reports on these cases should not only be sent to the clinicians in the second institution, but to the original reporting pathologist as well. If significant disagreement occurs, the case should be discussed with the original pathologist.
Design: The aim of this study was to assess the rate of major diagnostic discrepancies for cases sent from our institution to other medical centers, compliance regarding notification of the original pathologist about diagnostic discrepancies, and compliance with sending copies of pathology reports to the original institution in a 4 year period. This information was obtained from records kept in our institution when slides are sent to other centers, and our QA logs. A “major discrepancy” was defined as any change in diagnosis implying a different treatment or prognosis.
Results: From January 1, 2008 to December 12, 2011, our department issued reports on 83,320 surgical pathology cases. 3193 (3.8%) cases were sent to other medical centers for continuation of care. Of these, 2827 (88.5%) were sent to large hospitals/academic centers, and 366 (11.5%) were sent to community hospitals. Reports were received from institutions in only 1644 cases (51.4%), including 1458 from large centers (51.5%) and 186 from community hospitals (50.8%). There were two cases with major diagnostic discrepancies (0.06%), although no harm came to the patients. Of these two, in only one case did the reviewing pathologist notify and discuss the discrepancy over the phone with the contributing pathologist.
Conclusions: When reviewing institutional consult cases, hospitals are not compliant with sending copies of reports to the contributing pathologist in more than 49% of cases. Pathologists reviewing institutional consultations are not compliant with notifying the contributing pathologist of major diagnostic discrepancies. Because follow up reports were not received for almost half of the cases, the number of cases with diagnostic discrepancies is unkown. An effort has to be made by directors of surgical pathology laboratories to emphasize the importance of such communications.
Category: Quality Assurance
Tuesday, March 5, 2013 9:30 AM
Poster Session III # 257, Tuesday Morning