Jan F. Silverman, MD, Allegheny General Hospital, Drexel University College of Medicine, Pittsburgh, PA and William J. Frable, MD, Virginia Commonwealth University Medical Center, Richmond, VA
Since the 1999 Institute of Medicineís report on deaths due to medical errors, the medical community has made an increased effort to decrease medical errors and build a safer health system. It is estimated that 70% of all medical decisions that affect or change the patientís clinical course is related to lab data and nearly all cancer diagnosis are based on the pathologistís interpretation of surgical pathology and cytopathology specimens. Accordingly, anatomic pathologists have an important role in patient safety. This course, using a case-study format and didactic presentation, will address the value and use of quality indicators in anatomic pathology, prevalence and types of errors in surgical pathology and cytopathology with an emphasis on patterns and recent trends in errors, and opportunities for process improvement and error prevention. The course will also discuss the value of standardization and protocol use in surgical pathology reporting, which better enables high quality reproducible data with decreased variation. The value of audit methods in surgical pathology and cytopathology will be emphasized, such as intra and extradepartmental consultations, audit of cases for clinicopathologic conferences, and focusing on types of cases especially in need of a second opinion. The practice of interinstitutional pathology consultations (second opinion) will be presented along with the incidence and more common types of discordant diagnosis. The concept of critical value (critical diagnosis) in anatomic pathology (similar to critical values in clinical pathology) will be presented along with the prevalence and perceptions of pathologists and clinicians of critical value cases, and problematic issues related to notification of critical values in anatomic pathology. In addition, guidelines for anatomic pathology critical values will be presented. The course will also address procedures and processes for reducing errors in GYN cytology and fine needle aspiration of breast biopsies. Medicolegal and risk management issues will be discussed along with strategies to avoid a malpractice action.
The course will emphasize cases that are prone to errors, importance of standardization and protocols, audit methods, the value of second opinion, critical value cases in anatomic pathology and risk management strategies and medicolegal issues. Time is allotted for questions and answers following the presentation.
Following the completion of the course, participants should be able to: 1) Identify the common types of errors in surgical pathology and cytopathology that need additional attention. 2) Develop strategies for process improvement and error reduction, appropriate audit methods and identify cases most often needing second opinion. 3) Develop standardized forms and protocols in surgical pathology reporting. 4) Identify cases that represent critical diagnosis (critical values) in anatomic pathology. 5) Understand the risk management and medicolegal implications of errors and strategies to avoid a malpractice action.
The course is designed for general pathologists, subspecialists, and residents. A CD-Rom of case histories and representative images will be available for mailing prior to the meeting. An extensive syllabus will be distributed at the time of the course and a CD of additional materials will be mailed after the meeting. (New Course)