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Are amended surgical pathology reports getting to the correct responsible care provider?
Vinita Parkash1, Akosua Domfeh1, Paul Cohen1
1From the Department of Pathology, Yale University School of Medicine, New Haven, CT; Department of Pathology, Bridgeport Hospital, Bridgeport, CT.
Objectives:
Amended reports (AmRs) need to follow patients to treating physicians, to avoid erroneous management based on the original diagnosis. This study was undertaken to determine if AmRs followed the patient appropriately.
Methods:
AmRs with diagnostic changes and discrepancies between ordering and treating physicians were tracked. Chart reviews, electronic medical report (EMR) reviews, and interviews were conducted to establish receipt of the AmR by the correct physician.
Results:
Seven of 60 AmRs had discrepancies between the ordering and treating physicians, all with malignant diagnoses. The AmR was present in the treating physician's chart in only one case. Ordering physicians indicated that AmRs were not forwarded to treating physicians when corrected results arrived after patient referral, under the assumption that the new physician was automatically forwarded pathology updates. No harm was documented in any of our cases. In one case with a significant amendment, the correct information was entered in the patient chart based on a tumor board discussion. A review of two electronic health record systems uncovered significant shortcomings in each delivery system.
Conclusions:
AmRs fail to follow the patient's chain of referrals to the correct care provider, and EMR systems lack the functionality to address this failure and alert clinical teams of amendments.
Insights
Amended reports (AmRs) often fail to reach the correct treating physician, potentially leading to incorrect patient management. Electronic medical record systems also lack features to ensure AmRs reach the right clinician.
Area of Science:
- Medical diagnostics
- Patient safety
- Healthcare informatics
Background:
- Amended reports (AmRs) are critical for accurate patient diagnosis and treatment.
- Ensuring AmRs reach treating physicians is essential to prevent management errors based on outdated information.
Purpose of the Study:
- To investigate the appropriate follow-through of AmRs to treating physicians.
- To identify systemic failures in the dissemination of amended diagnostic information.
Main Methods:
- Tracking AmRs with diagnostic changes and physician discrepancies.
- Conducting chart reviews, electronic medical record (EMR) reviews, and physician interviews.
- Assessing the receipt of AmRs by the correct treating physician.
Main Results:
- Seven of 60 AmRs (11.7%) showed discrepancies between ordering and treating physicians, all concerning malignant diagnoses.
- Only one of these seven AmRs was confirmed to be in the treating physician's chart.
- Ordering physicians assumed AmRs were automatically sent with patient referrals, a flawed assumption.
- Review of two EMR systems revealed significant delivery system deficiencies.
Conclusions:
- Amended reports frequently do not follow the patient's referral pathway to the appropriate care provider.
- Current EMR systems lack the necessary functionality to manage and alert clinical teams about report amendments.
