Critical diagnoses in cytopathology: Experience at a large medical center

Xing, Juan; Seigh, Lindsey; Ohori, N. Paul; Yousem, Samuel A.; Amin, Rajnikant M.; Pantanowitz, Liron

doi:10.1002/cncy.21896

Cited by 4 publications

(7 citation statements)

References 16 publications

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“…However, since the communication between pathologists and clinicians is frequently suboptimal and might result in misunderstandings, all reports should be conveyed in writing. Furthermore, semi-automated reporting via special codes can improve the quality of patient care [ 2 , 7 , 14 ].…”

Section: Discussionmentioning

confidence: 99%

“…In 1972, Lundberg first proposed the concept of critical value [ 1 ]. A critical value refers to a laboratory finding outside the normal range that might constitute an immediate health risk that would be otherwise difficult to detect [ 2 ]. It is also known as "critical diagnosis," "urgent diagnosis," and treatable, immediately life-threatening diagnosis."…”

Section: Introductionmentioning

confidence: 99%

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Critical value in surgical pathology: evaluating the current status in a multicenter study

Soleimani¹,

Sheibani²,

Khajeh³

et al. 2023

Diagn Pathol

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Background The concept of critical value is not evident in surgical pathology, and there is no established protocol for determining, reporting, and documenting these results. Materials and methods A questionnaire was designed regarding critical value in surgical pathology, and all pathologists and some clinicians from five laboratories were asked to participate through an invitation link. The most important items were selected, and all pathologists were instructed to follow a standard operating procedure to deal with critical results for a year. Results A total of 43 pathologists and 44 non-pathologists participated in the study. Some critical or unexpected items were selected. Most participants agreed that the optimal time to announce critical reports is within 24 h of establishing the final diagnosis, and a phone call was the most dependable communication option. In addition, the most qualified recipients were the attending physicians. Therefore, a written policy was implemented for a year. One hundred seventy-seven critical or unexpected cases (0.5%) were detected. Mucormycosis and cytomegalovirus (CMV) were the most frequent critical cases. Conclusion There are no set criteria for critical items or the reporting process in surgical pathology. It is possible to establish more uniform norms for reporting these cases by boosting pertinent research efforts and recruiting more pathologists and physicians. Additionally, it is advised that each medical facility compile its own unique critical or unexpected diagnosis list.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Critical value in surgical pathology: evaluating the current status in a multicenter study

Soleimani¹,

Sheibani²,

Khajeh³

et al. 2023

Diagn Pathol

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“…In particular, Nakhleh et al 11 found in a CAP survey of 1130 laboratories that only 75% had a written policy, and that no single diagnosis was regarded as critical by even half of laboratories. More recently, Xing et al 12 found increased use of a tracking code for cytology critical diagnoses in their laboratory information system among private hospitals within their medical system compared with the academic medical center, suggesting that clinicians in a private practice setting may desire more telephone communication than those in an academic setting, further supporting the need for institutional discretion. Along the way, a variety of editorial and review articles have also been published, which discussed the various issues involved with anatomic pathology critical values.…”

Section: Discussionmentioning

confidence: 99%

The Current State of Communication of Urgent and Significant, Unexpected Diagnoses in Anatomic Pathology

Staats

Parkash²,

Otis

et al. 2020

Archives of Pathology &Amp; Laboratory Medicine

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Context.— The concept of critical diagnoses in anatomic pathology is relatively recent and rigorous study of the issue is quite limited. The College of American Pathologists and Association of Directors of Anatomic and Surgical Pathology issued a consensus statement in 2012. There has been no multi-institutional study of communication policies since then. Objective.— To survey the policies of anatomic pathology laboratories regarding communication of critical values. Design.— A survey of the Association of Directors of Anatomic and Surgical Pathology membership was performed using a 14-question electronic survey tool. Results.— Responses were received from 38 institutions. Thirty-five of 38 (92%) had a policy on anatomic pathology critical values. Twenty-five of 38 (66%) respondents had read the College of American Pathologists/Association of Directors of Anatomic and Surgical Pathology consensus statement. Twelve of 38 (32%) institutions divided critical values into two categories, of which 9 used the College of American Pathologists/Association of Directors of Anatomic and Surgical Pathology terminology; 24 used only a single term, of which 11 used critical value. There was substantial variation in the diagnoses that were considered critical. A direct phone call to the responsible provider was uniformly considered an acceptable means of communication; all other methods had mixed or low support. The most common time frame was same day; many laboratories did not specify a timeframe. Most laboratories document date, time, and person to whom the result was communicated in the final report or an addendum report. Eighteen of 38 (47%) laboratories report an auditing mechanism for communication. Conclusions.— Policies for communication of critical/urgent/significant, unexpected results in anatomic pathology are the norm. However, there remains significant variation between institutions in the details of these policies.

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“…Xing et al investigated the quality assurance of critical diagnoses specific to cytopathology. The University of Pittsburgh Medical Center developed a semiautomated communication process for the communication of critical diagnoses known as MedTrak notification/CoPath tissue code TC66, which sent all final reports to the submitting physician via e‐mail and fax and notified him or her with a pager alert.…”

Section: Discussionmentioning

confidence: 99%

Perspectives and perceptions of urgent and alert values in surgical pathology and cytopathology: A survey of clinical practitioners and pathologists

Cretara

Otis

2018

Cancer Cytopathology

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In previous editorials, Chapman and Otis in 2011 and Layfield in 2014 have summarized much of the work responsible for establishing the concept of critical diagnoses in surgical pathology and cytopathology. Both editorials end with a list of 8 key policy points needed for an effective strategy of handling and communicating critical diagnoses. We have developed and distributed a Web‐based survey to elicit clinicians’ attitudes regarding many of those key policy points, such as how, when, and to whom critical diagnoses should be reported; we have allowed some level of collaboration with the clinical staff when developing our communication policies as the Association of Directors of Anatomic and Surgical Pathology (ADASP) consensus statement recommends. We have identified important areas of disagreement between pathologists and clinicians regarding what entities should be considered critical and who should be responsible for correlating histologic findings with the larger clinical context. Identifying these discordant points of view and fostering interdepartmental agreement on the best practices in the communication of critical diagnoses is an important patient care and safety issue. Chapman and Otis have also suggested the importance of increased access to accurate patient information and the clinical history, including the level of clinical suspicion of malignancy, and of forming a periodic review and quality assurance process. Here we explore methods of increasing the ability of pathologists and cytopathologists to identify unexpected diagnoses, including optimization of their workstations for better access to the electronic medical record, and we examine the progress of quality assurance methods in surgical pathology and cytopathology since the ADASP consensus statement in 2012.

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Critical diagnoses in cytopathology: Experience at a large medical center

Cited by 4 publications

References 16 publications

Critical value in surgical pathology: evaluating the current status in a multicenter study

Critical value in surgical pathology: evaluating the current status in a multicenter study

The Current State of Communication of Urgent and Significant, Unexpected Diagnoses in Anatomic Pathology

Perspectives and perceptions of urgent and alert values in surgical pathology and cytopathology: A survey of clinical practitioners and pathologists

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