[2009] "Urgent" Surgical Pathology Specimens; a Review and Comparison with Critical Values in Anatomical Pathology

Cliona M Ryan, Barbara M Loftus. Tallaght Hospital, Dublin, Ireland

Background: What is designated an urgent diagnosis in surgical pathology is highly subjective and open to interpretation from pathologists and clinicians. Attempts have been made to formalize the definition by the Association of Directors of Anatomic and Surgical Pathology (ADASP) with the publication of examples of critical diagnoses requiring verbal communication. In our practice it was observed that requests designated as “urgent” by clinicians were increasing. As local policy is to prioritize “urgent” specimens and phone the report to the clinician, it was felt that the increased number of “urgents” put an undue demand on resources. It was often unclear as to why the a specimen merited urgent processing therefore a review was undertaken to assess "urgent” specimens and comparison made with ADASP guidelines to assess which specimens warranted verbal communication.
Design: A review was performed of “urgent” specimens over six-months from 1st July to 31st December 2011. “Urgent” histological specimens were retrieved from a search on Winpath with a simultaneous search for SNOMED, quality and procedure codes. The turn around time (TAT) of these specimens was assessed and our standards of practice compared with international guidelines, which recommend a two-day TAT for urgent biopsies (80% threshold). A subset of these “urgent” requests was compared to ADASP examples of critical diagnoses.
Results: 4.23% of specimens (n= 587) were labeled “urgent”. 74.7% were biopsies, 23% malignant & 31% verbally communicated (n=183). Only 2.2% of requests (n=4) would require verbal communication as per ADASP guidelines on critical diagnoses [unexpected malignancies (n=2), acid fast bacilli (n=1), virus in an immunocompromised patient (n=1)]. TAT for all “urgent” specimens was 44% at two days. If was felt that “urgent” specimens directly communicated to the clinician were a truer reflection of urgent status. The TAT for this group was 65.5% at 2 days (69% for biopsies).
Conclusions: Differences exist between what pathologists and clinicians consider as urgent specimens. Inappropriate designation of some specimens as “urgent” may result in increased TAT and substandard compliance with international quality guidelines. Specimens designated as clinically urgent in surgical pathology do not necessarily equate to critical diagnoses requiring verbal communication to clinicians. We recommend that each institution compile a list of example critical diagnoses that require verbal communication and educate clinical teams as to appropriateness of designating specimens urgent.
Category: Quality Assurance

Tuesday, March 5, 2013 9:30 AM

Poster Session III # 256, Tuesday Morning

 

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