[521] A Retrospective Analysis of Consultation Activities in Clinical Pathology: Implications for Transformation and Resident Training

Christopher A Garcia, Robert L Schmidt, Jeanne Panlener, Brian R Jackson, Edward R Ashwood, Jerry W Hussong. University of Utah, Salt Lake City, UT

Background: The future role of pathologists has been the focus of increasing attention and there is a developing consensus on the need for pathologists to develop, expand and solidify their roles as consultants and active contributors to the patient's health care delivery team. Unfortunately, the consultative role of pathologists is not well documented. A better understanding of pathologists' roles and activities would provide an evidence base for discussions of change and for the design of residency training.
Design: We retrospectively reviewed our database of clinical consultation requests received by ARUP Laboratories for a one year period (9/2011-9/2012). 500 randomly selected cases were reviewed by two authors and classified by test performing lab and by reason for the consultation request (test selection, interpretation, performance characteristics, other).
Results: 3820 Consultation requests were received over the one year period. Residents handled 56% of these calls. The majority of requests were classified as chemistry (24.8%), microbiology (29.2%) and immunology (12.7%) as shown in Table 1. The major consultation topics were test interpretation (52%), selection (31%), and performance characteristics (21%), as shown in Table 2.

Distribution of Consultation Requests by Test Category
Test CategoryPercent
Chemistry24.8
Coagulation1.3
Endocrinology7.8
Genetics/Molecular6.9
Hematopathology0.9
Immunology12.7
Microbiology29.2
Other6.4
Toxicology10.0




Distribution of Cases by Consultation Topic
Consultation Issue Percent of Cases*Percent of Category**
Test Selection 31.0 
 Selection of proper tests 39.5
 Sequencing and or timing of tests 16.0
 Recommendations concerning follow-up testing 35.0
Test Interpretation 52.0 
 Interpretation of results 87.0
 Analysis of unexpected results 10.1
Test Performance 20.6 
 Analysis and communication of reference ranges 21.8
 Influences of analytic and biologic factors on results 31.8
 Test evaluation (performance characteristics, methods, workload, cost) 44.5
Other 11.6 
 Specimen handling 53.2
 Report Issues 40.3
*Some cases involved multiple issues and therefore the percent of total cases is greater than 100. **Only major issues listed and therefore sum is less than 100.


Conclusions: Clinical consultation activities at our institution provide trainees with a broad and balanced exposure across a range of disciplines and consultation issues. As the frequency topics and issues change over time, documentation of these changes will allow for targeted and timely revision of trainee education.
Category: Education

Monday, March 4, 2013 9:30 AM

Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 74, Monday Morning

 

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