Quality in Surgical Pathology Communication and Reporting

in surgical pathology is complex and includes multiple facets. Objective.-To discuss different aspects of pathology practice that represent quality communication in surgical pathology. Data Sources.-Literature review. Conclusions.-Achieving quality communication in surgical pathology is dependent on pathologists addressing multiple situations including managing physicians' expectations for turnaround time and ancillary testing, understanding what information is needed to manage the patient at intraoperative consultation and in the final report, assuring adequate report content with the use of synoptic checklist reports, and using report formatting suggestions that aid report comprehension. Finally, the pathologists' availability to answer questions and discuss cases is an important factor in effective communication, including their willingness to verbally report urgent and significant unexpected diagnoses to ensure that important diagnoses are not overlooked. (Arch Pathol Lab Med. 2011;135:1394-1397 doi: 10.5858/arpa.2011-0192-RA) S urgical pathology communication and reporting is a multidimensional process that requires that versatile approaches be addressed fully The literature on medical errors indicates that communication mishaps are contributing factors in most errorsif not the primary problem-that leads to patient injury. PHYSICIAN SATISFACTION WITH SURGICAL PATHOLOGY DEPARTMENTS Two studies 6,7 have addressed physician or customer satisfaction with anatomic pathology. They demonstrate that anatomic pathology scores lowest on issues related to poor communication including report timeliness, communication of relevant information, and notification of significant results. Customer satisfaction measures a combination of customer expectation and how those expectations are addressed. Measuring customer satisfaction is very sensitive to issues of communication. If a laboratory does not communicate appropriate expectation of report turnaround time, physicians (customers) may develop unrealistic expectations that can never be met by the laboratory. Therefore, a situation is created that can never be fulfilled unless expectations are modified. Laboratories that communicate with physicians about the time needed for tissue processing or additional testing are frequently rewarded with higher scores and an overall better relationship with physician customers. Physicians also frequently convey this information to patients to demonstrate the necessary steps to produce quality information regarding their specimens and the treatment options based on the findings. This also demonstrates that pathologists' communications beyond the surgical pathology report are just as important as the report itself. REPORT CONTENT AND COMPLETENESS The most important and consistent product of pathology is the surgical pathology report. Making sure that the reports are formatted well and the content is complete represents the best quality improvements that a laboratory can make. There are published guidelines regarding the general substance of reports. 8 There are also extensive cancer checklist guidelines and other content guidelines, such as recommendations for transplant rejection criteria, to help make sure that the content is complete. 9 Using a synoptic checklist or computer checklist has been repeatedly demonstrated to be superior to free-text reports when it comes to inclusion of mandated elements, with a uniformly consistent product that is more easily understood by clinicians

Hepatoportal Sclerosis—A Clinicopathologic Review of 28 Cases

Background and Aims: The aim of this study was to review a large series of cases with hepatoportal sclerosis (HPS) as a pathologically recognizable entity in liver tissue specimens and describe the associated clinical and radiographic manifestations, along with the outcomes of this entity. Methods: Data were collected through a retrospective chart review. Results: Twenty-eight patients were identified that had pathologically defined HPS. All patients had a significant past medical history and signs and symptoms of portal hypertension. The most consistent laboratory finding was an elevated alkaline phosphatase. Radiographically, 9 patients were mistakenly identified as having advanced fibrosis/cirrhosis. The initial histologic diagnosis was made on biopsy in 20 patients and after transplant in 8 patients. The severity of symptoms was variable and required transplantation in 11 patients, 3 were treated with transjugular intrahepatic portosystemic shunt, and the remaining patients were treated symptomatically. Conclusion: HPS is associated with past medical history that may be causal in nature. Signs and symptoms may be severe enough to require liver transplantation. A significant proportion of patients are radiographically misdiagnosed as cirrhosis. In this small series, overall outcomes for transplanted patients are acceptable

Evaluating the Adoption of Laboratory Practice Guidelines.

CONTEXT.—: To date, the College of American Pathologists (CAP) has developed 17 laboratory practice guidelines (LPGs) including updates. In 2013, the CAP was awarded a 5-year cooperative agreement grant from the United States Centers for Disease Control and Prevention to increase the effectiveness of LPGs. OBJECTIVE.—: To assess the awareness and adoption of 2 CAP LPGs: immunohistochemical (IHC) assay validation and initial workup of acute leukemia. DESIGN.—: Baseline surveys for each LPG were conducted in 2010 and 2015, respectively. To measure the adoption of guideline recommendations and inform future updates, a follow-up study consisting of surveys, telephone interviews, and focus group sessions was conducted in laboratories that indicated they perform IHC testing. A follow-up study for the acute leukemia LPG is planned. RESULTS.—: For the IHC Validation LPG, a total of 1624 survey responses, 40 telephone interviews, and discussions with 5 focus group participants were analyzed. The response rate for the aforementioned 3 modalities was 46%, 13%, and 3%, respectively. All modalities indicated most respondents were aware of the LPG and had adopted most or all of its recommendations. Respondents expressed needs for continued communication, increased specificity, and more prescriptive recommendations when the guideline is updated. CONCLUSIONS.—: While data-driven development of evidence-based LPGs requires significant resources, active data collection to identify gaps and assess adoption contributes to improved laboratory testing practices in support of patient care. The CAP identified sustainable modalities to track metrics and developed multiple tools that should improve guideline development, adoption, and implementation. Of these modalities, written or electronic surveys were the most logistically feasible and had the highest response rate