Significant and Unexpected, and Critical Diagnoses in Surgical Pathology: A College of American Pathologists' Survey of 1130 Laboratories

Abstract

Abstract Context.—The Joint Commission and the College of American Pathologists have emphasized improved communication as a strategy to improve patient safety and reduce errors. Objective.—To determine current policies and practices concerning critical and/or significant and unexpected results in anatomic pathology. Design.—A survey was distributed with the 2007 D mailing of the Performance Improvement Program slides. The survey included questions that determined laboratory size, practice setting, and anatomic pathology critical and/or significant and unexpected result policies and practices. Results.—Surveys from 1130 laboratories were received. A total of 75% had a written policy regarding anatomic pathology critical and/or significant and unexpected results; 25% did not. A total of 30% of laboratories with written policies stated that their policies included guidelines but did not include specific examples. A total of 33% listed 5 or fewer specific examples, 18% listed more than 5 examples, and 19% stated that they had a specifically defined list of significant and unexpected and/or critical diagnoses. The conditions that were listed included malignancies (48% of all laboratories), findings not expected by the clinical history (45%), life-threatening infections (45%), no chorionic villi in products of conception (37%), inflammatory or immunologic processes (19%), and organ rejection (14%). Laboratories with a higher median number of accessioned surgical and cytology cases and independent laboratories tended to have policies with more than 5 specific examples or precise lists of must-call diagnoses (P < .001). Conclusions.—This survey illustrates current anatomic pathology policies and practices with respect to critical and significant and unexpected results.