[2033] Influence of External Factors on Frozen Section Performance

Joshua A Wisell, Sharon B Sams. University of Colorado School of Medicine, Aurora, CO

Background: Pathologists spend their days making decisions, mostly about the significance of histologic features observed during the routine practice of microscopic examination. Recently some have proposed that humans may have an individual capacity for decision-making throughout the day and once exhausted, the quality of this capacity degrades. Here we investigate whether external factors, as suggested by the concept of 'decision fatigue,' may impact upon the ability of a pathologist to render the best possible diagnosis at the time of frozen section (FS).
Design: We evaluated all FS performed within a six-month period at our tertiary level hospital and cancer center. For each FS several features were recorded including the time of day, if the FS diagnosis was discrepant from the final diagnosis and if the diagnosis was deferred at the time of FS. The discrepancies and deferrals were compared to the time of day that they occurred.
Results: Discrepancies and deferrals show a non-uniform frequency throughout the day, which demonstrate a similar pattern of occurrence, showing two periods of increased frequency.

TimeFS volumeDiscrepancy (%)Deferral (%)Discrepancy or Deferral (%)
<8112000
8-91783.603.5
9-101523.92.26.1
10-111317.91.39.2
11-121103.14.67.6
12-13922.71.03.6
13-14893.31.14.3
14-15784.52.26.7
15-16437.75.112.8
16-17344.74.79.3
17-18168.83.911.8





Conclusions: The first period with an increased frequency of discrepancies and deferrals occurs between 10 and 11 am, which follows the busiest period that occurs during the preceding hour. The second period of increased frequency is at the end of the day. The concept of decision fatigue could provide an explanation for this pattern, with increasing discrepancies and deferrals following the morning period of frequent decision-making and again after a full day of decisions. We acknowledge that this may not be the only explanation for our observed pattern of frozen section performance and further investigation will provide additional insight into the factors that underlie these findings. More importantly, further elucidation of influential external factors may provide opportunities for performance improvement initiatives.
Category: Quality Assurance

Monday, March 4, 2013 1:00 PM

Proffered Papers: Section G, Monday Afternoon

 

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