Significant and unexpected, and critical diagnoses in surgical pathology: a College of American Pathologists' survey of 1130 laboratories.
BACKGROUND
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.


METHODS
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.
Nakhleh
Raouf E
RE
Department of Pathology, Mayo Clinic Florida, Jacksonville, FL 32224, USA. Nakhleh.roauf@mayo.edu
Souers
Rhona
R
Brown
Richard W
RW
D003625:Data Collection; D003933:Diagnosis; D006306:Health Surveys; D006747:Hospital Communication Systems / Q000331:legislation & jurisprudence / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D033183:Interdisciplinary Communication; D007591:Joint Commission on Accreditation of Healthcare Organizations; D007755:Laboratories, Hospital / Q000331:legislation & jurisprudence / Q000592:standards* / Q000706:statistics & numerical data; D010340:Pathology, Surgical / Q000331:legislation & jurisprudence / Q000592:standards* / Q000706:statistics & numerical data; D011364:Professional Practice / Q000706:statistics & numerical data; D012015:Reference Standards; D014481:United States