Analysis of Addenda in Anatomic Pathology as a Quality Monitoring Initiative

Abstract

Our study demonstrates that not infrequently, surgical pathology addenda contain information that significantly alters the report and thus merit an amendment. Quality monitoring initiatives that evaluate pathologist and departmental performance should assess both addenda and amendments.

Decreased faux addenda following standardisation of pathologist practice

“…Our data, and those of others,3 4 highlight the challenges associated with having to make changes to an existing report in the electronic medical record, even in the setting of pending additional studies. There is a continuum of opinions in the pathology community, ranging from issuing a report as soon as possible, even in the setting of incomplete information, to waiting until all anticipated studies are complete to issue a final report.…”

“…Our institution showed a surprisingly high faux addenda rate at 3.2% pre-intervention compared with the previously published rates of 1.3% and 0.6% 3 4. Even after the statistically significant intervention we were still just under 1%.…”

“…The authors suggest several reasons for this including increased additional testing and increased focus on turnaround time. These studies also identified a high rate of so-called ‘faux’ addenda, a term coined by Babwah et al 3. Faux addenda are additions to a pathology report that change the diagnosis or prognosis and thus represent changes to the original diagnosis.…”

“…Recent studies have shown an increase in the rate of addenda usage over the past decade in surgical pathology 3 4. The authors suggest several reasons for this including increased additional testing and increased focus on turnaround time.…”

Quality assurance in dermatopathology: A review of report amendments

“…However, recent analyses have determined that oftentimes addenda are used erroneously by pathologists. A recent review of 5028 addenda determined that 33 of these were rather “faux addenda” and contained information better suited for an amendment, such as changes in diagnosis from benign to malignant 11 . Finkelstein et al reported that 5.6% of addenda reviewed at their institution contained information more appropriate for an amendment 12 .…”