Surgical pathology extradepartmental consultation practices.

The use of expert consultations in surgical pathology remains under-researched despite its clinical importance. Prior research has shown that consultations can influence diagnostic accuracy and patient outcomes. However, no prior work had resolved the specific consultation rates or factors affecting satisfaction in this field. This gap motivated a study to quantify consultation frequency and assess its impact on pathology practices. The study aimed to determine how often consultations occur and what factors influence their value. It also sought to identify which types of cases are most likely to be referred for consultation. The researchers focused on measuring consultation rates, turnaround times, and participant satisfaction. They also wanted to explore whether consultation outcomes varied by specimen type or consultant expertise. By examining these aspects, the study aimed to provide insights into current consultation practices and their effectiveness.

The study aimed to document the frequency and characteristics of surgical pathology consultations. It sought to measure consultation rates, participant satisfaction, and turnaround times across multiple institutions. The researchers wanted to determine whether consultation rates varied based on practice size or workload. They also aimed to identify the most common specimen types sent for consultation. Another goal was to assess how quickly consultations were completed and whether faster turnaround improved satisfaction. The study also aimed to evaluate the impact of consultation outcomes, such as confirmation of original diagnoses or addition of new information. The researchers wanted to understand how patient or clinician requests affected consultation satisfaction. Finally, they aimed to establish baseline data for future studies on consultation practices.

The study utilized data from the College of American Pathologists' Q-Probes program. Participants were asked to document up to 20 consultation cases over a four-month period. They recorded patient and specimen details, consultation reasons, and turnaround times. The researchers collected data from 180 laboratories across the U.S., Canada, and Australia. They analyzed consultation rates, median turnaround times, and participant satisfaction levels. The study categorized consultations based on specimen type and consultant expertise. It also examined whether consultation outcomes varied by case complexity or request source. The researchers used statistical methods to assess correlations between practice size and consultation rates.

The study found an aggregate consultation rate of 0.5%, with a median of 0.7%. Larger institutions and those with higher surgical case volumes had lower consultation rates. The median turnaround time was six days, with 29% of cases completed within three days and 68% within seven days. Fifty-two percent of cases were sent to nationally known experts, while 32% were sent to local experts. Skin, hematolymphoid, and breast specimens were most commonly referred for consultation. In 70.5% of cases, consultants confirmed the original diagnosis. In 15.9% of cases, consultants added significant diagnostic information. Satisfaction was higher with faster turnaround times and verbal reporting. Satisfaction was lower when consultations were requested by patients or clinicians and when diagnostic results were ambiguous.

The study established a multi-institutional consultation rate of 0.5%, with significant variation based on practice size and workload. It demonstrated that satisfaction with consultations is linked to faster turnaround times and receipt of additional diagnostic information. The findings suggest that consultation practices are influenced by institutional characteristics and case complexity. The researchers propose that consultation outcomes depend on the expertise of the consultant and the nature of the case. They note that patient or clinician-initiated consultations may lead to lower satisfaction. The study highlights the importance of timely reporting and clear communication in consultation processes. It also suggests that certain specimen types, such as skin and breast, are more frequently referred for consultation. The authors emphasize the need for further research into factors affecting consultation effectiveness and satisfaction.