Sometimes the burden of having to produce a ‘definitive’ diagnosis falls squarely on the pathologist’s shoulders. It is commonly held that the pathologist uses a battery of tests and stains to arrive at a “correct” diagnosis, whereas physicians engage in an “art” of interpretation and assumption.
However, reporting on pathology is rarely so straightforward. A lot depends on the performance of microscopic findings. As a result, pathologists can make mistakes similar to other medical professionals.
As far as we can infer from published reports, errors in pathology reporting constitute a tiny fraction of all instances. When mistakes do occur, however, they can have severe consequences for patient care and lead to costly lawsuits. Everybody stands to benefit from a sharp drop in mistake rates.
Despite catering to so many patients and being a multi-billion dollar institution, the case of incorrect reporting is significantly low.
Reasons Behind The Errors
A team can only make an accurate diagnosis with highly qualified specialists. Pathologists have this, along with years of expertise. So, how do blunders occur? There are many factors that could result in errors. Specimen management faults can be better pinpointed with the aid of error-identification methods developed by the industry.
Errors in the pre-analytic (wrong specimen labeling, delayed delivery to the laboratory, poor clinical information), analytic (wrong application of tests, errors in interpretation), and post-analytic (incorrect patient identification on the report, errors in interpreting the report findings) phases have all been uncovered.
For each pathologist, the most critical factor is ensuring that their training and CPD allow for precise interpretation of the sample and associated tests. Analyses of workplace errors reveal that ignorance, distraction, and prejudice in so-called “rapid-thinking” analysis are common causes of mistakes in the workplace.
People typically use “slow thinking,” or the methodical step-by-step processing of information to arrive at a diagnosis, when they are learning something new, but as they gain experience, they shift to “fast thinking,” or the recognition of patterns that allows some steps to be skipped in order to arrive at a conclusion quickly. Assumptions are more efficient overall but can cause mistakes.
According to studies, each year, 12 million Americans are affected by diagnostic mistakes. Only in the United States are 40,000 to 80,000 fatalities per year attributed to an incorrect diagnosis. Women and minorities have a 20 to 30 percent probability of being misdiagnosed with cancer.
It’s hard to say whether the increased number of legal cases is due to an actual increase in diagnostic mistakes or because the disease is so emotionally charged and possibly life-altering.
How To Reduce The Errors
Understanding the origins of mistakes can help us find solutions to cutting down on them. Safety implementation approaches, such as the 5S or Lean models, can be used to reduce the error rate. It is the first and most obvious point to make to ensure that procedural mistakes are minimized inside the department or unit.
Something as small as unclean air from the AC can affect the findings. To avoid this issue and create a perfect sanitary condition, labs must use cleanrooms to perform the tests.
They protect from dust, airborne microbes, and aerosol particles. Making sure the reports are free of errors as far as contamination is concerned. Depending on the size of the lab, creating custom modular cleanrooms becomes crucial in reducing error.
Depending on the use and classification requirements for your cleanroom, there are a variety of modular cleanroom design alternatives. It is possible for modular cleanrooms to integrate existing walls and structures from your facility or to stand alone as standalone buildings.
They can also use HVAC and already-existing equipment. For increased flexibility and portability, modular cleanrooms might have flexible walls that mimic tents or hard walls that resemble traditional construction.
Second, it’s important to make the most of the unit’s internal resources for training, continuing education, and morale. In reality, the error rate is lower in departments where reports are reviewed before being released.
Reports can be reviewed in a number of different ways, such as by the author, a second pathologist, or in a multi-disciplinary meeting. An administrator may perform a simple assessment to see whether anything was overlooked throughout the review process. This final illustration emphasizes the significance of checking the report to make sure it contains all the necessary information.
By creating checklists for a variety of diagnoses, the American College of Surgeons ensured that all relevant information was included in the vast majority of reports backed by the College of American Pathologists.
The use of synoptic reporting has been shown to reduce the number of omissions significantly. For example, one group found report completeness of 88% when synoptic reporting was utilized, compared to 34% when it was not.
It has been discovered that using synoptic reporting tools, which can create aspects of the diagnosis (such as staging information for cancer) based on the pathologist’s inputs, might further enhance reporting quality by lowering the likelihood of ‘rapid thinking’ bias and assumptions.
Long Story Short:
Pathology reporting errors are uncommon but can have serious repercussions for the patient and result in costly lawsuits. Whether it’s due to forgetfulness or general unfamiliarity with the diagnosis and all the material needed, omissions are a common source of trouble.
This is made more difficult by the growing complexity of diagnosis and the increased use of ancillary testing. The thoroughness and correctness of reports are greatly enhanced by synoptic reporting.
When there are discrepancies in a diagnosis, it may be necessary to consult with a peer or a second institution for an opinion.