title: Analysis of addenda in anatomic pathology as a quality monitoring initiative.
abstract: BACKGROUND
  Along with the integration of immunohistochemical markers and molecular techniques into routine practice, addenda in surgical pathology reporting have not only increased in frequency but also evolved to include prognostic and therapeutic information. Because of the lack of uniform practice with respect to issuing addenda, information that can significantly change the diagnosis, prognosis, or treatment plan may be issued as an addendum as opposed to an amendment.
  
  
  OBJECTIVE
  To audit addenda and identify instances of amendments masquerading as addenda.
  
  
  METHODS
  All addenda during a 36-month period were reviewed. Each addendum report was classified by accession class, issuing pathologist, subspecialty category, indication for addendum, whether the addendum constituted a change in diagnostic meaning, whether a change in prognosis occurred, and if a change in treatment plan was necessary.
  
  
  RESULTS
  All cytology and autopsy addenda were deemed appropriate. Thirty-three of 5028 (6.5 of 1000) surgical pathology addenda were deemed to have changes: Among the 33 faux addenda, 30 (91%) contained supplemental diagnostic information that would alter patient management and 31 (94%) contained additional information that would change the prognosis from that entailed by the original diagnosis.
  
  
  CONCLUSIONS
  Our study demonstrates that not infrequently, surgical pathology addenda contain information that significantly alters the report and thus merit an amendment. Quality monitoring initiatives that evaluate pathologist and departmental performance should assess both addenda and amendments.
authors.affiliation: From the Department of Laboratory Medicine and Pathobiology, The University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
authors.forename: Jesse Paul
authors.initials: JP
authors.lastname: Babwah
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Khalifa
authors.forename: Corwyn
authors.initials: C
authors.lastname: Rowsell
mesh_terms: D001344:Autopsy / Q000592:standards; D003581:Cytodiagnosis / Q000592:standards; D003951:Diagnostic Errors; D006801:Humans; D010340:Pathology, Surgical / Q000592:standards*; D011786:Quality Control; D058028:Research Report / Q000592:standards