Quality assurance measures for critical diagnoses in anatomic pathology

American Journal of Clinical Pathology
Andrew A Renshaw, Edwin W Gould

Abstract

We sought to characterize how well computerized "case flags" performed in evaluating critical diagnoses in anatomic pathology. All cases identified by a pathologist at sign-out and flagged as a critical diagnosis in anatomic pathology in 2 hospital laboratories during a 3-year period were reviewed. A subset of all critical diagnoses consisting of only treatable, immediately life-threatening (TILT) diagnoses was selected, and a text search for key words was used to evaluate performance during a 6-month period. During a 3-year period, there were 635 cases (0.5% of all cases) that were flagged as critical diagnoses. A key word search identified 269 TILT cases, which represented 1.8% of all cases during this time; 30 (11.2%) were critical diagnoses, of which 24 (80%) had documentation of a call to the clinician and only 2 (7%) were flagged as a critical diagnosis. Critical diagnoses in anatomic pathology remain poorly defined. Computerized case flags underestimate the number of critical diagnosis cases in a laboratory and cannot identify missed critical diagnoses. A more limited and clearly defined approach to quality assurance of critical diagnoses emphasizing TILT diagnoses and selected key word searches can be performed and requ...Continue Reading

References

Jul 27, 2006·Human Pathology·UNKNOWN Association of Directors of Anatomic and Surgical PathologyPaul E Swanson
Oct 16, 2008·American Journal of Clinical Pathology·Telma C PereiraPaul E Swanson

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