A pathology report is a truly actionable document, guiding diagnostic and prognostic decisions. Accordingly, pathology report errors can have dire consequences for patients. Inaccurate reports and inefficient workflows both have negative effects on patient care.
Incomplete pathology reports can make it difficult for care teams to move forward, but inaccurate pathology reports can be far worse. As clinical research reviews have concluded, “Even minor typographic errors can profoundly alter the meaning of a report”.
Pathology Error Prevention Best Practices
The College of American Pathologists (CAP) Laboratory Accreditation Program recommends that all laboratories create patient safety plans to develop and implement quality assurance measures unique to their lab’s workflows. While each lab will require a different approach, there is a growing body of literature outlining best practices for pathology labs seeking to ensure patient safety.
A consistent concern in the research on pathology report errors is the long-standing lack of consistency in defining and reporting errors. One emerging paradigm in pathology literature is a tripartite system that acknowledges three different points where pathology errors occur.
1. Pre-Analytic Pathology Errors
Pre-analytic errors occur in the ordering, transferring, preparation and accessioning of samples. Many of these errors are outside of a pathology lab’s control. Poor communication from surgeons or primary care physicians can create significant confusion during accessioning and analysis. But strong procedures can help pathologists to prevent some of these errors. For example, pathology workflow will substantially differ depending on whether a referring physician is seeking a diagnosis or to assess the efficacy of treatment. To understand this difference, pathologists need to understand the context of the analysis. Understanding context requires clear communication.
CAP recommends establishing standard procedures for communicating with care team partners, such as mutually developed lists of acceptable abbreviations, acronyms, and symbols to prevent confusion. Moreover, labs should determine how referring physicians are able to deliver (and receive) reports, whether through system-to-system interfaces or standardized codes like ICD-10. Necessary information should not be lost in unmonitored email accounts.
A best practice for pathologists is to communicate with their patient care partners clearly and thoroughly via standardized codes and interoperable electronic medical records (EMRs). Procedures will sometimes need to be unique to different physicians or wards, and should be established prior to test ordering.
2. Analytic Pathology Errors
Analytic-phase errors are those that pathologists bear the greatest responsibility for preventing. Research recommends that lab administrators provide their teams with consistent training and ensure that their teams follow standardized procedures, such as the use of CAP clinical templates. Nevertheless, it is also recommended that pathologists seek second opinions in complex cases. The best pathologists recognize the expertise of their peers.
Crucially, the analytic phase includes the pathology reporting process. Clinical research consistently shows that synoptic reporting methods help pathologists to produce reports that are more complete, consistent and accurate, particularly when compared to transcribed dictations or narrative text. The best synoptic reporting software includes immediate error-checking and configurable alerts.
A best practice is to implement synoptic reporting software that offers a balance of consistency and configurability. Customizable CAP templates allow pathologists to ensure patient safety through standardization, while adapting to the unique needs of different labs, physicians and patients.
3. Post-Analytic Pathology Errors
The post-analytic phase is often when problems from earlier stages become apparent, underscoring the importance of preventive best practices. Most post-analytic errors overlap with shortcomings in other phases, and so it’s best to take a holistic approach to quality assurance.
Pathology report timeliness depends on both the reporting methods used in the analytic phase and post-analytic distribution methods. Interoperable lab information and reporting systems can greatly reduce turnaround times. The post-analytic misdelivery or delay of a pathology report can undo the hard work of pathologists and have substantial negative effects on patient outcomes.
A best practice for preventing this error is to use software that enables lab administrators to configure immediate distribution via referring providers’ preferred methods. Again, the use of interoperable EMRs can streamline this process, and pre-distribuition error checking is a must.
Synoptic Reporting for Quality Assurance
Synoptic pathology reporting improves care team communication and workflow, preventing errors at all three phases of the pathology process. Standard structure and language help to prevent problems that commonly arise through dictated and narrative reporting: typographic errors, inconsistent formats, incomplete information, and turnaround delays.
Synoptic reporting software, with the right balance of standardization and customization, enables pathologists to produce consistently complete reports that properly express the value of their work. The right pathology reporting systems streamline workflows and improve patient safety through reducing medical report errors.
The right synoptic reporting software enables administrators to aggregate and search reports, to review performance and develop quality assurance measures, further preventing pathology report errors.
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