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PubMed2003

Concordance with breast cancer pathology reporting practice guidelines.

BACKGROUND: Accurate pathology reporting is important for treatment of breast cancer. The College of American Pathologists (CAP) distributed guidelines for reporting cancer specimens in 1998. The aim of this study was to determine community-wide concordance with CAP breast cancer reporting guidelines. STUDY DESIGN: Pathology reporting of stage I and II breast cancers was examined for adherence to CAP guidelines. Pathology reports were reviewed from 100 consecutive cases of invasive breast cancers referred to Roswell Park Cancer Institute in 1998 to 1999 from community hospitals after excisional breast biopsy and 20 consecutive cases with excisional biopsy at RPCI. Adherence to CAP guidelines for clinically relevant items was determined from the original pathology report in each case. RESULTS: One hundred one cases met the inclusion criteria. Most reports did not include at least one of the guideline required elements. Surgical margins were inked in only 77%, and the margins oriented in only 25% of patients. Many specimens were not oriented by the surgeon. Grade was reported in most cases, but the Bloom Scarf Richardson grade was reported in only 6%. The presence or absence of lymphovascular invasion, and of coexisting in situ disease, was reported in 57% and 71%, respectively. The extent and type of in situ disease was reported in 47% and 49%, respectively. CONCLUSIONS: Breast cancer pathology reporting varies widely. Key elements that affect treatment are often omitted. These include gross description and size, orientation and involvement of surgical margins, and description of histologic features, including Bloom Scarf Richardson reporting of grade and the extent of an in situ component. Passive distribution of CAP practice guidelines might be insufficient to accomplish community-wide quality improvement in breast pathology reporting.

Breast Neoplasms↗
PubMed1999

Referral patterns, lesion prevalence, and patient care parameters in a clinical oral pathology practice.

OBJECTIVE: The purpose of this study was to determine the following parameters in a referral-based private practice oral and maxillofacial pathology clinic: (1) sources of clinical referrals; (2) types of problems referred; and (3) clinical effectiveness of treatment. STUDY DESIGN: Clinical charts were reviewed for a cohort of 362 patients seen over a 2 1/2-year period (1993-1995). From these charts, we determined the source of referral and the final diagnosis for each patient. In addition, 50 patients were randomly selected and surveyed by telephone; each was asked a series of questions to determine the following: (1) the number of health care practitioners previously seen with regard to the patient's condition; (2) the length of time that the condition had been present before the patient came to the oral and maxillofacial pathology clinic; (3) the costs associated with medications and office visits that had been incurred before the patient came to the oral and maxillofacial pathology clinic; (4) the costs associated with medications and office visits that were incurred at the oral and maxillofacial pathology clinic; and (5) the patient's level of satisfaction with the oral and maxillofacial pathology clinic. RESULTS: Fifty-five percent of the referrals came from dentists, and 45% came from physicians. The 3 problems most commonly seen were candidiasis (12%), burning mouth syndrome (10%), and lichen planus (8%). For the 50 patients who were interviewed, the mean number of health care practitioners seen previously was 2.2 (range, 1-9). The mean time from initial symptoms to evaluation by an oral pathologist was 15 months. The mean approximate cost of medications and office visits before evaluation by an oral pathologist was $350 (range, $30-$4,000; median, $100); this compared with a cost of $94 (range, $50-$300; median, $70) for the patient visit and medications associated with the oral pathology appointment. The difference was statistically significant (P < or = .001). CONCLUSIONS: This preliminary study suggests that the clinical evaluation of oral lesions by an oral pathologist appears to be cost-effective and should be an integral part of a comprehensive health management system. These results should be corroborated by similar multicenter studies.

Adolescent↗
PubMed2002

Ethical and professional issues in pathology: a survey of current issues and educational efforts.

Professionalism, including ethics, has assumed greater importance in residency education, and the Accreditation Council for Graduate Medical Education now requires its incorporation into residency training. Insight into current ethics education, as well as those ethical issues important to pathology, would be efficacious. A mail survey was sent to all members of the Association of Pathology Chairs that asked for specific information related to pathology resident education in ethics and identification of important ethical issues in the current practice of pathology. A total of 148 surveys were mailed, and 53 (35.8%) were returned. Formal instruction in ethics is provided by approximately 62% of pathology residency training programs, and 94% provide informal ethics education. However, 84% of programs believed that ethical issues were underrecognized, and 38% believed that current ethics training was inadequate. Issues regarding the use of tissue for research, confidentiality and privacy, and professionalism were identified as the most important ethical issues currently encountered in pathology.

Bioethics↗
PubMed2003

Supporting the implementation of breast pathology recommendations: feasibility of a feedback mechanism to pathologists.

AIMS: The aims of the study were to explore the feasibility, acceptability, impact and cost of a feedback program to pathologists reporting on breast specimens through a BreastScreen Service. METHODS: The study was conducted at a single BreastScreen NSW Screening and Assessment Service. Pathology reports were audited against the ACN recommendations about pathology reporting [Australian Cancer Network Pathology Working Party. The Pathology Reporting of Breast Cancer: a guide for pathologists, surgeons and radiologists. Sydney: Australian Cancer Network, 1997] during two consecutive periods. Feedback was provided to pathologists at the completion of each audit. A comparison of completeness of pathology reports between audits was undertaken. The Screening and Assessment Service staff and participating pathologists were interviewed to assess acceptability and information about resource allocation. RESULTS: The study demonstrated that the feedback mechanism was acceptable to pathologists and staff at the BreastScreen Screening and Assessment Service, and that participation in the study resulted in some improvements in pathology reporting. CONCLUSIONS: The study demonstrated the feasibility of providing feedback to pathologists about their reporting of breast specimens. However, there were costs to the Service of participating. A way of managing these costs would need to be explored if the feedback mechanism was made a routine BreastScreen procedure.

Breast Diseases↗
PubMed1997

The ASCP Resident Physician Section: results of surveys pertaining to "graduated responsibility for residents in anatomic pathology". American Society of Cytopathology.

Graduated responsibility for residents in anatomic pathology has been the subject of discussion among supervising staff and residents during the past few years. Presently a wide variation exists within pathology residency programs in the United States both in the degree of autonomy given to residents and in the areas of anatomic pathology (ie, surgical pathology, cytopathology, and autopsy pathology) within which the autonomy is granted. Recent surveys of supervising staff and residents have indicated a willingness to increase the level of independence for residents, especially at senior levels. Impediments include reimbursement, credentialing, and medicolegal issues. The results of the ASCP-Resident Physician Section (RPS) surveys pertaining to graduated responsibility for residents in anatomic pathology are discussed.

Data Collection↗
PubMed2000

Dusting off old books: comments on classic gynecologic pathology books of yesteryear.

Selected outstanding books from the older literature on gynecological pathology are reviewed with emphasis on drawing attention to the abundant helpful information and outstanding illustrations that are worthy of review by present-day pathologists. The first three works are Cancer of the Uterus, Myomata of the Uterus, and Adenomyoma of the Uterus by Thomas S. Cullen. The senior author of the second book is Howard A. Kelly even though he did not have any role in the preparation of the text; he was given senior authorship by Dr. Cullen as a token of appreciation to his mentor. The next book, Fibroids and Allied Tumors by Cuthbert Lockyer, is particularly noteworthy for the quality of the numerous color illustrations. The final book on the uterus is The Cervix Uteri and Its Diseases by C. Frederic Fluhmann. It provides detailed coverage of the normal and pathologic aspects of the cervix, including the endocervical clefts (glands) and their abnormalities. The next three books are on the ovary: Ovarian Tumors by Samuel H. Geist, Atlas of Ovarian Tumors by Gemma Barzilai, and Endocrine Pathology of the Ovary by John McLean Morris and Robert E. Scully. The first is notable for the quality of the coverage of clinical and gross aspects of ovarian tumors and the second for the quality of the description of the microscopic features. The third book expanded the range of functioning ovarian tumors by showing that this could be a feature of tumors not usually considered hormonally active and also discussed in detail the endocrine function of non-neoplastic lesions. The final two books cover general gynecological pathology: Manual of Obstetrical and Gynaecological Pathology by John H. Teacher and Gynecological and Obstetrical Pathology by Emil Novak. Both have particularly outstanding coverage of normal histology and non-neoplastic lesions.

Female↗
PubMed1996

Is pathology examination of disc specimens necessary after routine anterior cervical discectomy and fusion?

STUDY DESIGN: A retrospective chart review was performed from 1990-1994. OBJECTIVES: To evaluate the outcome of pathologic examination of cervical disc specimens submitted after anterior cervical discectomy. SUMMARY OF BACKGROUND DATA: This study is the first to review the outcome of pathologic examination of disc specimens after anterior cervical discectomy and fusion. METHODS: Charts were reviewed based on the procedure code of anterior cervical fusion and the main diagnoses of cervical disc and spondylosis. The following data were recorded for each patient: symptoms, examination, diagnostic studies, operative procedure, operative findings, and pathology report. Statistical analysis was performed. RESULTS: Five hundred six disc levels in 394 patients were reviewed. All patients had symptoms and examination results consistent with cervical radiculopathy. All patients had cervical radiographs and some combination of myelography, computed tomography, or magnetic resonance imaging. Findings at the time of surgery included the presence of either a herniated disc or degenerative spondylitic changes. The pathologic examination results of all specimens reported fibrocartilaginous tissue consistent with disc material with the presence of degenerative changes. No infectious, benign, or malignant process was identified at the time of surgery or on gross and histologic examination of any of the disc specimens. Using confidence intervals (95%) for exact proportions and given 500 negatives, the chance the next occurrence would be positive would be 0.0060 or 0.60% or six of 1000. CONCLUSIONS: This study shows that if the symptoms, physical examination, radiographic diagnostic studies, and surgical findings are consistent with those of cervical disc herniation of spondylosis, the chance of an unexpected, clinically important pathologic finding within the disc specimen is extremely small. The time and expense involved in routine pathologic examination of cervical disc specimens can be avoided.

Cervical Vertebrae↗
PubMedDate not supplied

Variability in gross and microscopic pathology reporting in excisional biopsies of breast cancer tissue.

Accurate and complete information in pathology reporting is essential since most breast cancer treatment decisions are based on pathologic findings. The College of American Pathologists (CAP) has guidelines for breast cancer reporting; however, pathology reports remain variable. Data were collected on 91 consecutive breast cancer excisional biopsies from "outside slide review" (OSR) cases for a 2-year period to determine the variability in pathology reports in gross and microscopic examinations from 50 different outside community and university hospitals located primarily in the southwestern United States. From the gross pathology report, the following items were analyzed: measurement and weight of specimens, orientation provided by surgeons, number of blocks submitted, designation of margins, and whether margins were indicated as "shaved" or "perpendicular" in relation to the breast tissue at the time of grossing. From the final diagnoses, the following items were analyzed: type and size of tumor, and surgical margins. The results show that 100% of the reports documented the measurement of specimen size, and 30% documented the specimen weight. Surgeons provided orientation of the breast specimens in 65% of cases. Surgical margins were inked in 58%, while only 18% described how margins were submitted (either shaved or perpendicular to the mass). Only 30% of specimens were submitted in toto, 1% were submitted with an unknown amount of tissue, and 69% were submitted in representative sections with an average of 13 blocks for lumpectomies. In the final diagnoses, all reports had documentation of the tumor type and size of the invasive cancer; 26% of the final diagnoses had ductal carcinoma in situ (DCIS) and just 5% of those reports documented the size of the DCIS. The surgical margin status was reported in only 76% of the final diagnoses. This study shows that the pathology reports were heterogeneous with respect to reporting gross and microscopic final diagnoses from the variable hospitals.

Adult↗
PubMed2004

Teaching and learning pathology: a critical review of the English literature.

AIM: There are few publications summarising the main issues concerning pathology teaching and learning within undergraduate medical degrees. This article examines the themes that have emerged from the literature over the last 2 decades. METHOD: A literature search was performed using PubMed, which identified 86 relevant papers in the English language. RESULTS: The themes discussed in the literature included the timing and duration of pathology courses, the appropriate pathology teacher for medical students, the teaching strategies used for pathology, and the methods used to assess learning. DISCUSSION: With the gradual increase of integrated medical curricula, it is important for pathology teachers to engage in the change process and help to shape the new-style courses. One of the positive aspects of change is that it can provide an opportunity to rethink current practice. It is hoped that this paper might stimulate discussion about how pathology is taught and learnt, leading to further developments in this area.

Curriculum↗
PubMed1996

A review of pathology reporting for breast cancer.

BACKGROUND: A detailed pathology report is important in the determination of treatment options and prognosis in breast cancer. Australia's first National Cancer Consensus Conference, held in 1994, recommended guidelines for the standardization of the clinical information to be provided to the pathologist, the specifications relating to the handling of specimens, and the resultant pathology report. METHODS: We examined the current status of pathology reporting in invasive breast cancer in three New South Wales hospitals from 1986 to 1994. RESULTS: Histopathologic type was documented in 99% of reports, grade was documented in 47%, size in 46%, and lymph node status in 98%. Only 27% of pathology reports reviewed documented the status of all the above parameters in the one report. Other features such as lymphatic and vascular invasion were documented in only 21% and 9% of pathology reports, respectively, while sex steroid receptor status was reported in almost 90% of cases. CONCLUSIONS: In view of the wide range in the percentage of features reported, we recommend the use of a standardized checklist for the pathological assessment of surgically resected invasive breast cancer specimens.

Adult↗
PubMed2005

SNOMED representation of explanatory knowledge in veterinary clinical pathology.

BACKGROUND: The Systematized Nomenclature of Medicine (SNOMED) is an established standard nomenclature for the expression of human and veterinary medical concepts. Nomenclature standards ease sharing of medical information, create common points of understanding, and improve data aggregation and analysis. OBJECTIVES: The objective of this study was to determine whether SNOMED adequately represented concepts relevant to veterinary clinical pathology. METHODS: Concepts were isolated from 3 different types of clinical pathology documents: 1) a textbook (Textbook), 2) the Results sections of industry pathology reports (Findings), and Discussion sections from industry pathology reports (Discussion). Concepts were matched (mapped) by 2 reviewers to semantically-equivalent SNOMED concepts. A quality score of 3 (good match), 2 (problem match), or 1 (no match) was recorded along with the SNOMED hierarchical location of each mapped concept. Results were analyzed using Cohen's Kappa statistic to assess reviewer agreement and chi-square tests to evaluate association between document type and quality score. RESULTS: The percentage of good matches was 48.3% for the Textbook, 45.4% for Findings, and 47.5% for Discussion documents, with no significant difference among documents. Of remaining concepts, 40% were partially expressed by SNOMED and 14% did not match. Mean reviewer agreement on quality score assignments was 76.8%. CONCLUSIONS: Although SNOMED representation of veterinary clinical pathology content was limited, missing and problem concepts were confined to a relatively small area of terminology. This limitation should be addressed in revisions of SNOMED to optimize SNOMED for veterinary clinical pathology applications.

Information Storage and Retrieval↗
PubMed1996

Use of oral pathology services by general histopathologists and their attitudes to training of oral pathologists.

AIMS: (1) To determine whether general histopathologists are aware of oral pathology as a specialist discipline and whether they use oral pathologists to identify lesions of the dental and orofacial tissues which pose diagnostic difficulties to general histopathologists. (2) To establish whether consultant histopathologists would consider dentally qualified applicants for salaried training posts within their department so that they may fulfil College accreditation requirements. METHODS: A questionnaire was sent to a consultant histopathologist in each of 226 general histopathology departments in England and Wales. RESULTS: In total, 167 (74%) consultant histopathologists completed the questionnaire, of whom 98% (163/167) were aware of the specialty and 92% (153/167) perceived a need for it. Oral biopsy specimens formed less than 5% of the workload in 76% (126/167) of departments, but 80% (134/167) of the consultants had referred at least one case to an oral pathologist during 1993. The most common sources of diagnostic difficulty were identified as salivary gland pathology, odontogenic tumours and lesions of oral mucosa. Only 22% (36/167) of consultants were aware that trainees in oral pathology are obliged to spend a year in accredited general histopathology training, but 40% (67/167) said they would consider a dentally qualified applicant for a training post in their department. CONCLUSIONS: General histopathologists are aware that oral pathologists exist and most will at some time call on their services; thus there is a need for specialists in oral pathology. Consultant histopathologists have a supportive attitude to the problem of providing the necessary general experience for oral pathology trainees, which will continue to be obtained through secondment to a histopathology department outside the trainee's main institution in most cases. Central funding would help the problem of providing cover for trainees spending a year out to complete general pathology training.

Attitude of Health Personnel↗
PubMed2005

Development and preliminary evaluation of the VPS ReplaySuite: a virtual double-headed microscope for pathology.

BACKGROUND: Advances in computing and telecommunications have resulted in the availability of a range of online tools for use in pathology training and quality assurance. The majority focus on either enabling pathologists to examine and diagnose cases, or providing image archives that serve as reference material. Limited emphasis has been placed on analysing the diagnostic process used by pathologists to reach a diagnosis and using this as a resource for improving diagnostic performance. METHODS: The ReplaySuite is an online pathology software tool that presents archived virtual slide examinations to pathologists in an accessible video-like format, similar to observing examinations with a double-headed microscope. Delivered through a customized web browser, it utilises PHP (Hypertext PreProcessor) to interact with a remote database and retrieve data describing virtual slide examinations, performed using the Virtual Pathology Slide (VPS). To demonstrate the technology and conduct a preliminary evaluation of pathologists opinions on its potential application in pathology training and quality assurance, 70 pathologists were invited to use the application to review their own and other pathologists examinations of 10 needle-core breast biopsies and complete an electronic survey. 9 pathologists participated, and all subsequently completed an exit survey. RESULTS: Of those who replayed an examination by another pathologist, 83.3% (5/6) agreed that replays provided an insight into the examining pathologists diagnosis and 33.3% (2/6) reconsidered their own diagnosis for at least one case. Of those who reconsidered their original diagnosis, all re-classified either concordant with group consensus or original glass slide diagnosis. 77.7% (7/9) of all participants, and all 3 participants who replayed more than 10 examinations stated the ReplaySuite to be of some or great benefit in pathology training and quality assurance. CONCLUSION: Participants conclude the ReplaySuite to be of some or of great potential benefit to pathology training and quality assurance and consider the ReplaySuite to be beneficial in evaluating the diagnostic trace of an examination. The ReplaySuite removes temporal and spatial issues that surround the use of double-headed microscopes by allowing examinations to be reviewed at different times and in different locations to the original examination. While the evaluation set was limited and potentially subject to bias, the response of participants was favourable. Further work is planned to determine whether use of the ReplaySuite can result in improved diagnostic ability.

Archives↗
PubMed2006

[Clinical pathology].

This work describes the basic elements of pathology used in clinical practice. Pathology plays an important role in clinical and scientific work, but only a few areas of pathology will be covered. Although the contribution of oncological and surgical pathology to therapy is the most well known, the cases chosen here will involve infectious pathology, diseases of the kidney and the liver, autoimmune diseases, as well as organ transplantation. Especially important is the description of methods that enable more accurate morphological diagnoses, such as histochemistry, immunohistochemistry, immunofluorescence, and electronic microscopy. Previous experience and joint work with clinical doctors have enabled the definition of significant morphological elements as well as of essential methods of pathohistological diagnosis. Besides, as is often the case, although disease symptoms are difficult to discern and biochemical results do not show significant changes compared to normal values, the results of biopsy come as a surprise to clinical doctors. For example, in virus hepatitis B involving so-called asymptomatic HBsAg carriers, we discovered every morphological form of hepatitis, from minimal lesions to chronic, persistent, and active hepatitis. With hepatitis C, certain morphological lesions point to the etiopathogenesis of this disease and thus help to confirm the diagnosis and to instigate therapy on time. Another significant experience involves kidney biopsies in cases when clinical findings are asymptomatic. Often, in such cases, morphological findings point to glomerulonephritis and glomerulopathy at different stages. Timely and subtle morphological diagnostics offer a more precise explanation for the pathological injury of tissues than other diagnostic methods. In this way, by adopting new methods, the work of pathologists is included more and more in everyday clinical practice. The inclusion of pathologists in a transplantation team makes sure a proper selection of the organ for transplantation is carried out and ensures a reliable evaluation of the condition of the transplanted organ, enabling appropriate therapy. Autoimmune, hereditary diseases are almost impossible to recognise unless a biopsy is performed as in the examples given. In this work, the 30-year-long results of the cooperation between clinical doctors and pathologists are presented and compared with similar results from modern literature, together with numerous examples that represent significant experiences and achievements of our medicine.

Humans↗
PubMed2003

Customer satisfaction in anatomic pathology. A College of American Pathologists Q-Probes study of 3065 physician surveys from 94 laboratories.

CONTEXT: Measurement of physicians' and patients' satisfaction with laboratory services has recently become a requirement of health care accreditation agencies in the United States. To our knowledge, this is the first customer satisfaction survey of anatomic pathology services to provide a standardized tool and benchmarks for subsequent measures of satisfaction. OBJECTIVE: This Q-Probes study assessed physician satisfaction with anatomic pathology laboratory services and sought to determine characteristics that correlate with a high level of physician satisfaction. DESIGN: In January 2001, each laboratory used standardized survey forms to assess physician customer satisfaction with 10 specific elements of service in anatomic pathology and an overall satisfaction rating based on a scale of rankings from a 5 for excellent to a 1 for poor. Data from up to 50 surveys returned per laboratory were compiled and analyzed by the College of American Pathologists. A general questionnaire collected information about types of services offered and each laboratory's quality assurance initiatives to determine characteristics that correlate with a high level of physician satisfaction. SETTING: Hospital-based laboratories in the United States (95.8%), as well as others from Canada and Australia. PARTICIPANTS: Ninety-four voluntary subscriber laboratories in the College of American Pathologists Q-Probes quality improvement program participated in this survey. Roughly 70% of respondents were from hospitals with occupied bedsizes of 300 or less, 65% were private nonprofit institutions, just over half were located in cities, one third were teaching hospitals, and 19% had pathology residency training programs. MAIN OUTCOME MEASURES: Overall physician satisfaction with anatomic pathology and 10 selected aspects of the laboratory service (professional interaction, diagnostic accuracy, pathologist responsiveness to problems, pathologist accessibility for frozen section, tumor board presentations, courtesy of secretarial and technical staff, communication of relevant information, teaching conferences and courses, notification of significant abnormal results, and timeliness of reporting). RESULTS: The database of 3065 physician surveys was derived from 94 laboratories. An average of 32.6 surveys (median 30) was returned per institution, with a range of 5 to 50 surveys per institution. The mean response rate was 35.6% (median 32.5%). The median (50th percentile) laboratory had an overall median satisfaction score of 4.4. The lowest satisfaction scores that were obtained all related to poor communication, which included timeliness of reporting, communication of relevant information, and notification of significant abnormal results. Statistically significant associations of customer satisfaction with certain institutional characteristics and laboratory performance improvement activities were identified. CONCLUSIONS: The importance of this satisfaction survey lies not in its requirement as an exercise for accrediting agencies but in understanding the needs of the customer (in this case the physician) to direct performance improvement in the delivery of quality anatomic pathology laboratory services.

Consumer Behavior↗
PubMed2003

Pathology resident attitudes and opinions about pathologists' assistants.

CONTEXT: Changes in health care economics and organization have resulted in increased use of nonphysician providers in most health care settings. Attitudinal acceptance of nonphysician providers is important in the current health care environment. OBJECTIVES: To obtain descriptive information regarding pathology resident attitudes and opinions about pathologists' assistants in anatomic pathology practice and to assess the implications of resident attitudes and opinions for pathology practice and training. DESIGN: A self-administered, mailed, voluntary, anonymous questionnaire was distributed to a cross-sectional sample of pathology residents in the United States (2531 pathology residents registered as resident members of one of the national pathology professional organizations). The questionnaire contained (1) items relating to resident demographics and program characteristics, (2) Likert-scale response items containing positive and negative statements about pathologists' assistants, (3) a multiple-choice item related to pathologists' assistants scope of practice, and (4) an open-ended item inviting additional comments. Both quantitative and qualitative analysis of responses was performed. RESULTS: The overall response rate was 19.4% (n = 490); 50% of the respondents were women, and 77% reported use of pathologists' assistants in their program. Most respondents were 25 to 35 years old and in postgraduate years 3 through 5 of their training, and most were located in the Midwestern United States. The majority of residents expressed overall positive attitudes and opinions about pathologists' assistants and felt that pathologists' assistants enhanced resident training by optimizing resident workload. A minority (10%-20%) of residents expressed negative attitudes or opinions about pathologists' assistants. Additionally, some residents reported a lack of knowledge about pathologists' assistants' training or roles. CONCLUSIONS: Increased resident education and open discussion concerning pathologists' assistants may be beneficial for optimizing resident attitudes about and training experiences with pathologists' assistants.

Adult↗
PubMed2005

Anatomic pathology databases and patient safety.

CONTEXT: The utility of anatomic pathology discrepancies has not been rigorously studied. OBJECTIVE: To outline how databases may be used to study anatomic pathology patient safety. DESIGN: The Agency for Healthcare Research and Quality funded the creation of a national anatomic pathology errors database to establish benchmarks for error frequency. The database is used to track more frequent errors and errors that result in more serious harm, in order to design quality improvement interventions intended to reduce these types of errors. In the first year of funding, 4 institutions (University of Pittsburgh, Henry Ford Hospital, University of Iowa, and Western Pennsylvania Hospital) reported cytologic-histologic correlation error data after standardizing correlation methods. Root cause analysis was performed to determine sources of error, and error reduction plans were implemented. PARTICIPANTS: Four institutions self-reported anatomic pathology error data. MAIN OUTCOME MEASURES: Frequency of cytologic-histologic correlation error, case type, cause of error (sampling or interpretation), and effect of error on patient outcome (ie, no harm, near miss, and harm). RESULTS: The institutional gynecologic cytologic-histologic correlation error frequency ranged from 0.17% to 0.63%, using the denominator of all Papanicolaou tests. Based on the nongynecologic cytologic-histologic correlation data, the specimen sites with the highest discrepancy frequency (by project site) were lung (ranging from 16.5% to 62.3% of all errors) and urinary bladder (ranging from 4.4% to 25.0%). Most errors detected by the gynecologic cytologic-histologic correlation process were no-harm events (ranging from 10.7% to 43.2% by project site). Root cause analysis identified sources of error on both the clinical and pathology sides of the process, and error intervention programs are currently being implemented to improve patient safety. CONCLUSIONS: A multi-institutional anatomic pathology error database may be used to benchmark practices and target specific high-frequency errors or errors with high clinical impact. These error reduction programs have national import.

Benchmarking↗
PubMed2006

Determining customer satisfaction in anatomic pathology.

CONTEXT: Measurement of physicians' and patients' satisfaction with laboratory services has become a standard practice in the United States, prompted by national accreditation requirements. Unlike other surveys of hospital-, outpatient care-, or physician-related activities, no ongoing, comprehensive customer satisfaction survey of anatomic pathology services is available for subscription that would allow continual benchmarking against peer laboratories. Pathologists, therefore, must often design their own local assessment tools to determine physician satisfaction in anatomic pathology. OBJECTIVE: To describe satisfaction survey design that would elicit specific information from physician customers about key elements of anatomic pathology services. DESIGN: The author shares his experience in biannually assessing customer satisfaction in anatomic pathology with survey tools designed at the Henry Ford Hospital, Detroit, Mich. Benchmarks for physician satisfaction, opportunities for improvement, and characteristics that correlated with a high level of physician satisfaction were identified nationally from a standardized survey tool used by 94 laboratories in the 2001 College of American Pathologists Q-Probes quality improvement program. RESULTS: In general, physicians are most satisfied with professional diagnostic services and least satisfied with pathology services related to poor communication. CONCLUSIONS: A well-designed and conducted customer satisfaction survey is an opportunity for pathologists to periodically educate physician customers about services offered, manage unrealistic expectations, and understand the evolving needs of the physician customer. Armed with current information from physician customers, the pathologist is better able to strategically plan for resources that facilitate performance improvements in anatomic pathology laboratory services that align with evolving clinical needs in health care delivery.

Consumer Behavior↗