Measuring the Clinical Impact of Pathologist Reviews of Blood and Body Fluid Smears

Abstract

Context.—Despite the widespread practice of pathologist review of blood and body fluid smears, little is known about its impact on improving patient care. Objective.—To assess the clinical usefulness of pathologist review of blood and body fluid smears. Design.—Survey study. Pathology residents contacted the ordering physician after pathologist reviews were reported to assess their clinical impact. Results.—Ninety-six pathologist reviews met criteria for study inclusion, and 64 ordering physicians were successfully contacted during the 2-month study period. Of the 64 cases, 19 reviews (30%) had been seen by the physician within 24 to 48 hours after the report was issued and 33 (51%) had not been seen; in 4 (6%) instances, physicians did not remember whether they had seen the review. Eight reviews (13%) were considered urgent enough to warrant immediate communication by the pathologist. Of the 27 reviews that were seen or directly communicated, 23 (85%) contributed to clinical diagnosis and/or patient management. Conclusions.—This study demonstrates the contribution of pathologist reviews of blood and body fluids to clinical diagnosis and patient management. The results also highlight the problem of a lack of physician awareness of clinical pathology results.

Educational cost-effective intervention to reduce pathologist’s peripheral blood smears reviews with non-contributory findings: an academic institution experience

“…To evaluate the added value of PBS, Sandhaus et al retrospectively interviewed ordering physicians within 48 hours of 64 signed out cases. 10 Surprisingly, 51% of ordering physicians replied that they had not seen the results, 30% replied that they had seen the results, 6% did not remember the results, and 13% were contacted directly regarding urgent findings. Possible explanations for poor follow-up within the study included ordering physicians going off service, designating staff to check results, following up results after 2 days, orders from the emergency department when the patient was already discharged, or denial of knowledge of the order.…”

“…Possible explanations for poor follow-up within the study included ordering physicians going off service, designating staff to check results, following up results after 2 days, orders from the emergency department when the patient was already discharged, or denial of knowledge of the order. 10 Due to lack of urgency and inadequate follow-up of results from ordering clinicians, these studies question the clinical utility of PBS review.…”