Quantifying the value of in-house consultation in surgical pathology.
In-house consultation is a well-known method to improve diagnostic accuracy and agreement, but the technique has not been well studied. We reviewed the results of in-house consultation in a large private hospital practice setting for a 1-month period and determined its effect on diagnostic accuracy using the final sign-out as the "gold standard." During this 1-month period, 352 cases were reviewed as in-house consultations. Initial complete agreement was found in 315 (89.5%) cases. Using the initial diagnosis as the test case and the final sign-out as the gold standard, of the 37 discrepant cases, 4 (1.1%) were thought to represent false-negative results, (0.3%) a false-positive result, 3 (0.9%) differences in type, and 29 (8.2%) differences in diagnostic threshold. Disagreements in 10 cases were thought to be potentially clinically significant. Internal consultation was obtained on approximately 20% of all cases seen in the laboratory and disagreements were found in 2% of all cases. Internal consultation has a significant and measurable impact on the practice of surgical pathology.
Renshaw
Andrew A
AA
Department of Pathology, Baptist Hospital of Miami, FL 33176, USA.
Pinnar
Nat E
NE
Jiroutek
Michael R
MR
Young
Mary L
ML
D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D016304:Hospitals, Private; D006801:Humans; D008297:Male; D010340:Pathology, Surgical / Q000379:methods*; D018024:Peer Review, Health Care; D011785:Quality Assurance, Health Care; D012017:Referral and Consultation; D015203:Reproducibility of Results