title: Subspecialty surgical pathologist's performances as triage pathologists on a telepathology-enabled quality assurance surgical pathology service: A human factors study.
abstract: BACKGROUND
  The case triage practice workflow model was used to manage incoming cases on a telepathology-enabled surgical pathology quality assurance (QA) service. Maximizing efficiency of workflow and the use of pathologist time requires detailed information on factors that influence telepathologists' decision-making on a surgical pathology QA service, which was gathered and analyzed in this study.
  
  
  METHODS
  Surgical pathology report reviews and telepathology service logs were audited, for 1862 consecutive telepathology QA cases accrued from a single Arizona rural hospital over a 51 month period. Ten university faculty telepathologists served as the case readers. Each telepathologist had an area of subspecialty surgical pathology expertise (i.e. gastrointestinal pathology, dermatopathology, etc.) but functioned largely as a general surgical pathologist while on this telepathology-enabled QA service. They handled all incoming cases during their individual 1-h telepathology sessions, regardless of the nature of the organ systems represented in the real-time incoming stream of outside surgical pathology cases.
  
  
  RESULTS
  The 10 participating telepathologists' postAmerican Board of pathology examination experience ranged from 3 to 36 years. This is a surrogate for age. About 91% of incoming cases were immediately signed out regardless of the subspecialty surgical pathologists' area of surgical pathology expertise. One hundred and seventy cases (9.13%) were deferred. Case concurrence rates with the provisional surgical pathology diagnosis of the referring pathologist, for incoming cases, averaged 94.3%, but ranged from 88.46% to 100% for individual telepathologists. Telepathology case deferral rates, for second opinions or immunohistochemistry, ranged from 4.79% to 21.26%. Differences in concordance rates and deferral rates among telepathologists, for incoming cases, were significant but did not correlate with years of experience as a practicing pathologist. Coincidental overlaps of the area of subspecialty surgical pathology expertise with organ-related incoming cases did not influence decisions by the telepathologists to either defer those cases or to agree or disagree with the referring pathologist's provisional diagnoses.
  
  
  CONCLUSIONS
  Subspecialty surgical pathologists effectively served as general surgical pathologists on a telepathology-based surgical pathology QA service. Concurrence rates with incoming surgical pathology report diagnoses, and case deferral rates, varied significantly among the 10 on-service telepathologists. We found no evidence that the higher deferral rates correlated with improving the accuracy or quality of the surgical pathology reports.
authors: Department of Pathology, University of Arizona College of Medicine, Tucson, AZ, USA.
authors: Beth L
authors: BL
authors: Braunhut
authors: Department of Pathology, University of Arizona College of Medicine, Tucson, AZ, USA ; Arizona Telemedicine Program, University of Arizona College of Medicine, Tucson, AZ, USA.
authors: Anna R
authors: AR
authors: Graham
authors: Department of Pathology, University of Arizona College of Medicine, Tucson, AZ, USA.
authors: Fangru
authors: F
authors: Lian
authors: Arizona Telemedicine Program, University of Arizona College of Medicine, Tucson, AZ, USA.
authors: Phyllis D
authors: PD
authors: Webster
authors: Arizona Telemedicine Program, University of Arizona College of Medicine, Tucson, AZ, USA ; Department of Medical Imaging, University of Arizona College of Medicine, Tucson, AZ, USA.
authors: Elizabeth A
authors: EA
authors: Krupinski
authors: Department of Pathology, University of Arizona College of Medicine, Tucson, AZ, USA.
authors: Achyut K
authors: AK
authors: Bhattacharyya
authors: Department of Pathology, University of Arizona College of Medicine, Tucson, AZ, USA ; Arizona Telemedicine Program, University of Arizona College of Medicine, Tucson, AZ, USA.
authors: Ronald S
authors: RS
authors: Weinstein
keywords: Diagnostic accuracy; digital pathology; quality assurance; robotic telepathology; surgical pathology; telepathology