Second-opinion pathologic review is a patient safety mechanism that helps reduce error and decrease waste.
OBJECTIVE
We have a crisis in health care delivery, originating from increasing health care costs and inconsistent quality-of-care measures. During the past several years, value-based health care delivery has gained increasing attention as an approach to control costs and improve quality. One proven way to control costs and improve the quality of health care is subspecialty pathologic review of patients with cancer before initiation of therapy. Our study examined the diagnostic error rate among patients with cancer treated at a tertiary care hospital and demonstrated the value of subspecialty pathologic review before initiation of treatment.


METHODS
From September 1 to September 30, 2011, all patients seeking a clinical consultation had pathology submitted to and reviewed by a pathologist with subspecialty expertise and correlated in our pathology database.


RESULTS
A total of 2,718 patient cases were reviewed during September 2011. There was agreement between the original pathologist and our departmental subspecialty pathologist in 75% of cases. In 25% of cases, there was a discrepancy between the original pathology report and the subspecialty final pathology report; 509 changes in diagnosis were minor discrepancies (18.7%), and in 6.2% of patients (169 reports), the change in diagnosis represented a major discrepancy that potentially affected patient care.


CONCLUSIONS
Second review of a patient's outside pathology by a subspecialist pathologist demonstrates the value of multidisciplinary cancer care in a high-volume comprehensive cancer center. The second review improves clinical outcomes by providing patients with evidence-based treatment plans for their precise pathologic diagnoses.
University of Texas MD Anderson Cancer Center, Houston, TX lpmiddleton@mdanderson.org.
Lavinia P
LP
Middleton
University of Texas MD Anderson Cancer Center, Houston, TX.
Thomas W
TW
Feeley
University of Texas MD Anderson Cancer Center, Houston, TX.
Heidi W
HW
Albright
University of Texas MD Anderson Cancer Center, Houston, TX.
Ron
R
Walters
University of Texas MD Anderson Cancer Center, Houston, TX.
Stanley H
SH
Hamilton
D005260:Female; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000191:economics / Q000473:pathology*; D010336:Pathology / Q000379:methods* / Q000592:standards; D061214:Patient Safety / Q000592:standards*; D012017:Referral and Consultation / Q000191:economics / Q000592:standards*