Showing papers by "Stephen S. Raab published in 2010"

Quality in cancer diagnosis.

Abstract: Improving the quality of oncologic pathology diagnosis is immensely important as the overwhelming majority of the approximately 1.6 million patients who will be diagnosed with cancer in 2010 have their diagnoses established through the pathologic interpretation of a tissue sample. Millions more patients have tissue samples obtained to rule out cancer and do not have cancer. The majority of studies on the quality of oncologic pathology diagnoses have focused on patient safety and have documented a variety of causes of error that occur in the clinical and pathology laboratory testing phases of diagnostic testing. The reported frequency of a diagnostic error made by oncologic pathology depends on several factors, such as definitions and detection methods, and ranges from 1% to 15%. The large majority of diagnostic errors do not result in severe harm, although mild to moderate harm in the form of additional testing or diagnostic delays occurs in up to 50% of errors. Clinical practitioners play an essential role in error reduction through several avenues such as effective test ordering, providing accurate and pertinent clinical information, procuring high-quality specimens, providing timely follow-up on test results, effectively communicating on potentially discrepant diagnoses, and advocating second opinions on the pathology diagnosis in specific situations.

Adequacy of surgical pathology reporting of cancer: a College of American Pathologists Q-Probes study of 86 institutions.

Abstract: Context.—Inclusion of all scientifically validated elements in surgical pathology cancer reports is needed for optimal patient care. Objective.—To evaluate the frequency with which surgical pathology cancer reports contain all the scientifically validated elements required by the American College of Surgery (ACS) Commission on Cancer (CoC), the extent to which checklists are used, and the effects that the use of checklists have on the completeness of cancer reports. Design.—Participants in the College of American Pathologists voluntary Q-Probes program reviewed 25 consecutive surgical pathology reports to include cancer reports from breast, colon, rectum, and prostate cancer specimens. For each report, the type and total number of missing required elements, deemed essential by the ACS CoC, was recorded. Results.—A total of 2125 cancer reports were reviewed in 86 institutions; 68.8% of all surgical pathology cancer reports included all the required elements. Institutions in which checklists were r...

Overview of Diagnostic Terminology and Reporting

Abstract: The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) established a uniform, tiered reporting system for thyroid fine needle aspiration (FNA) specimens. TBSRTC recommends that every thyroid FNA report begin with one of six diagnostic categories: (1) nondiagnostic or unsatisfactory, (2) benign, (3) atypia of undetermined significance (AUS) or follicular lesion of undetermined significance (FLUS), (4) follicular neoplasm or suspicious for a follicular neoplasm, (5) suspicious for malignancy, and (6) malignant. It offers a choice of two different names for three of the six categories: a laboratory should choose the one it prefers and use it exclusively for that category. Synonymous terms (e.g., AUS and FLUS) should not be used to denote two distinct interpretations. Each category has an implied cancer risk that ranges from 0 to 3% for the “benign” category to virtually 100% for the “malignant” category, and, in this second edition, the malignancy risks have been revised based on additional (post first edition) data. As a function of these risk associations, each category is linked to evidence-based clinical management guidelines. The recent reclassification of some thyroid neoplasms as noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) has implications for the risk of malignancy, and this is accounted for in this chapter. For some of the general diagnostic categories, subcategorization can be informative and is often appropriate. Additional descriptive comments (beyond such subcategorization) are optional and left to the discretion of the cytopathologist. Notes and recommendations can be useful, especially due to the introduction of NIFTP.

Secondary case review methods and anatomic pathology culture.

Abstract: In this issue of the Journal , Owens and colleagues1 at the University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, describe the development of a patient safety information technology (IT) tool. Because this tool only recently has been implemented, Owens et al1 chose not to evaluate the effectiveness of the tool as a patient safety improvement initiative and preferred to evaluate the tool on its effect on timeliness, another Institute of Medicine (IOM) quality metric.2 The work of Owens et al1 highlights the relationship of patient safety to other quality domains, error detection, and quality improvement in surgical pathology. The IOM defined 6 domains of quality: safety, effectiveness, efficiency, timeliness, equity, and patient centeredness.2 During the past several decades, most of the published work in the anatomic pathology medical literature has focused on the domains of safety and timeliness. The 6 quality domains are not independent, as illustrated by the data reported by Owens et al.1 For many surgical pathologists, the mantra has become “get it right and get it (out) fast,” and efforts to change a specific practice domain (eg, safety) may lead to unforeseen changes in other domains (eg, timeliness). The fact that Owens et al1 measured turnaround time indicated that they were concerned that possible delays in case sign-out may have occurred because of newly introduced processes. Owens et al1 reported a slight increase in median case turnaround time following implementation of their patient safety IT tool. Outlier analysis was not performed, which possibly is a more important measure. Barriers to improve a specific quality metric are many and include the lack of organizational commitment or focus and investment in competing quality metrics. Organizational culture strongly affects the ability of front-line personnel to improve health care delivery, especially safe …

Use of a medical ITS improves reporting performance among community pathologists

Abstract: In previous work, we have developed an advanced medical training system based on the cognitive ITS paradigm In multiple laboratory studies, we showed a marked performance improvement among physicians in training We now report on the evaluation of our tutoring system as a potential patient safety intervention among practicing community physicians Fourteen community pathologists were matched for years of practice, and then randomly assigned to intervention or control groups Participants in the intervention group used the tutoring system for a total of 4-19 (mean 115) hours over 1-4 (mean 31) sessions over a period of 37-138 (mean 86) days Participants in the control group studied standard continuing medical education (CME) materials for a similar amount of time over a similar interval All participants took glass slide pre-tests and post-tests, and virtual slide interval tests Participants in the intervention group showed a significant improvement in the completeness of their surgical pathology reports when compared to the control group (p<001, RM-ANOVA) There was no significant gain for diagnostic reasoning, likely due to the already high performance levels and small number of participants