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.
|Consultation Issue||Percent of Cases*||Percent of Category**|
|Selection of proper tests||39.5|
|Sequencing and or timing of tests||16.0|
|Recommendations concerning follow-up testing||35.0|
|Interpretation of results||87.0|
|Analysis of unexpected results||10.1|
|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|