Amended reports: development and validation of a taxonomy of defects.
Amended pathology reports produce rework, confusion, and distrust. To develop a reproducible amendment taxonomy we derived a classification from 141 amended reports, then validated it with 130 new cases before 4 observers independently reviewed 430 cases measuring agreement (k). Next, agreement in classifying 30 other amended reports in 7 institutions was measured. We further tracked amendment rates, defect categories, defect discoverers, and discovery mechanisms. In the 430-case validation set agreement was excellent (k = 0.8780 [range, 0.8416-0.9144]). Among the 7 institutions, agreement was good (k = 0.6235 [range, 0.3105-0.8975]). Amendment rates ranged from 2.6 to 4.8 per 1,000 reports. Misinterpretation fractions varied least (23%-29%). Misidentification fractions ranged more widely (20%-38%). Specimen defects were least frequent (4%-10%) and report defects most frequent (29%-48%). Misidentifications and report defects inversely correlated. Pathologists discovered most misinterpretations, and clinicians found most misidentifications. Conference review revealed 40% to 80% of misinterpretations. This taxonomy produced excellent reproducibility and good agreement across institutions.
Meier
Frederick A
FA
Department of Pathology and Laboratory Medicine, Henry Ford Hospital, Detroit, MI 48202, USA.
Zarbo
Richard J
RJ
Varney
Ruan C
RC
Bonsal
Mona
M
Schultz
Daniel S
DS
Vrbin
Colleen M
CM
Grzybicki
Dana M
DM
Raab
Stephen S
SS
D003951:Diagnostic Errors / Q000145:classification*; D006801:Humans; D010338:Pathology, Clinical / Q000379:methods*; D017064:Process Assessment, Health Care; D011786:Quality Control