title: Improved quality of patient care through routine second review of histopathology specimens prior to multidisciplinary meetings.
abstract: OBJECTIVE
  Double reading may be a valuable tool for improving quality of patient care by identifying diagnostic errors before final sign-out, but standard double reading would significantly increase costs of pathology. We assessed the added value of intradepartmental routine double reading of histopathology specimens prior to multidisciplinary meetings.
  
  
  METHODS
  Diagnoses, treatment plans and prognoses of patients are often discussed at multidisciplinary meetings. As part of the daily routine, all pathology specimens to be discussed at upcoming multidisciplinary meetings undergo prior intradepartmental double reading. We identified all histopathology specimens from 2013 that underwent such double reading and determined major and minor discordance rates based on clinical relevance between the initial and consensus sign-out diagnoses.
  
  
  RESULTS
  We included 6796 histopathology specimens that underwent double reading, representing approximately 8% of all histopathology cases at our institution in 2013. Double reading diagnoses were concordant in 6566 specimens (96.6%). Major and minor discordances were observed in 60 (0.9%) and 170 (2.5%) specimens, respectively. Urology specimens had significantly more discordances than other tissues of origin, Gleason grading of prostate cancer biopsies being the most frequent diagnostic problem. Furthermore, premalignant and malignant cases showed significantly higher discordance rates than the rest. The vast majority (90%) of discordances represented changes within the same diagnostic category (eg, malignant to malignant).
  
  
  CONCLUSIONS
  Routine double reading of histopathology specimens prior to multidisciplinary meetings prevents diagnostic errors. It resulted in about 1% discordant diagnoses of potential clinical significance, indicating that second review is worthwhile in terms of patient safety and quality of patient care.
authors.affiliation: Symbiant Pathology Expert Centre, Alkmaar, The Netherlands Department of Pathology, University Medical Centre Utrecht, Utrecht, The Netherlands PALGA, Houten, The Netherlands.
authors.forename: Chantal C H J
authors.initials: CC
authors.lastname: Kuijpers
authors.affiliation: Symbiant Pathology Expert Centre, Alkmaar, The Netherlands.
authors.forename: Gerard
authors.initials: G
authors.lastname: Burger
authors.affiliation: Symbiant Pathology Expert Centre, Alkmaar, The Netherlands.
authors.forename: Shaimaa
authors.initials: S
authors.lastname: Al-Janabi
authors.affiliation: Department of Pathology, University Medical Centre Utrecht, Utrecht, The Netherlands.
authors.forename: Stefan M
authors.initials: SM
authors.lastname: Willems
authors.affiliation: Department of Pathology, University Medical Centre Utrecht, Utrecht, The Netherlands.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: van Diest
authors.affiliation: Symbiant Pathology Expert Centre, Alkmaar, The Netherlands Department of Pathology, University Medical Centre Utrecht, Utrecht, The Netherlands.
authors.forename: Mehdi
authors.initials: M
authors.lastname: Jiwa
mesh_terms: D001706:Biopsy; D003951:Diagnostic Errors / Q000517:prevention & control*; D005260:Female; D006801:Humans; D033183:Interdisciplinary Communication; D008297:Male; D060787:Neoplasm Grading; D009369:Neoplasms / Q000175:diagnosis* / Q000473:pathology; D010338:Pathology, Clinical / Q000379:methods*; D005791:Patient Care; D011467:Prostate / Q000473:pathology; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000473:pathology; D011785:Quality Assurance, Health Care; D058996:Quality Improvement; D012017:Referral and Consultation; D012189:Retrospective Studies
keywords: DIAGNOSTICS; HISTOPATHOLOGY; QUALITY ASSURANCE; SAFETY