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Quality assurance in dermatopathology: A review of report amendments
Margaret Cocks1, Alejandro A Gru2
1Department of Dermatology, University of Utah, Salt Lake City, Utah, USA.
Background:
Systematic review of amended reports in surgical pathology has been recommended as a valuable exercise in promoting quality assurance and improvement. Examination of report amendments can identify defects in the surgical pathology process and inspire new approaches to decreasing error rates and improving overall patient care.
Methods:
We performed a retrospective review of all amended dermatopathology reports over a 1.5-year period at a large academic institution.
Results:
During the study period, 86 amended reports out of a total 7950 skin-specific reports were issued (1.08%). Of these amended reports, about 59% (51/86) were because of non-interpretative errors (eg, wrong site, chin vs shin, etc.) while 41% (35/86) were diagnostic misinterpretations. Of these 35, 24 were considered major diagnostic changes while six were minor. Five amendments provided additional diagnostic information. Of those amended reports with diagnostic misinterpretations, 14/35 involved melanocytic lesions, 8/35 involved non-melanoma skin cancers or keratinocyte atypia, 10/35 were inflammatory lesions and 3/35 involved other tumors.
Conclusion:
Our review points to several quality improvement areas that can be targeted to potentially avoid diagnostic errors in dermatopathology, including standardizing certain anatomic sites to prevent misidentification and seeking out clinicopathologic correlation in challenging melanocytic cases.
Insights
Analyzing amended dermatopathology reports revealed that over half of errors were non-interpretive. Quality improvement efforts should focus on standardizing anatomic site identification and enhancing clinicopathologic correlation for challenging melanocytic lesions.
Area of Science:
- Dermatopathology
- Surgical Pathology
- Medical Quality Assurance
Background:
- Systematic reviews of amended surgical pathology reports are crucial for quality assurance and improvement.
- Examining report amendments helps identify process defects and reduce error rates.
Purpose of the Study:
- To analyze the types and causes of amended dermatopathology reports.
- To identify areas for quality improvement in dermatopathology reporting.
Main Methods:
- Retrospective review of amended dermatopathology reports over a 1.5-year period.
- Categorization of amendments into interpretative and non-interpretive errors.
Main Results:
- 1.08% (86/7950) of skin-specific reports were amended.
- 59% of amendments were for non-interpretive errors (e.g., site misidentification).
- 41% of amendments were for diagnostic misinterpretations, with 24 major changes, primarily involving melanocytic lesions and skin cancers.
Conclusions:
- Targeted quality improvements can reduce diagnostic errors in dermatopathology.
- Standardizing anatomic site descriptions can prevent misidentification.
- Emphasizing clinicopathologic correlation is vital for challenging melanocytic cases.
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