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The Anatomic Pathology Hospitalist Model : A Novel Approach to Frozen Section Practice in a Tertiary Care Center
Ellen E Chapel1, David B Chapel1, L Priya Kunju1
1From the Department of Pathology, Michigan Medicine, University of Michigan, Ann Arbor. Pantanowitz is currently affiliated with the Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. E. Chapel, D. Chapel, and Kunju equally shared the responsibilities of first author for this manuscript.
Context.—:
Challenges to staffing a high-quality frozen section service include consolidation of health systems and pathology practices, off-campus relocation of some pathology offices, growing numbers of stand-alone surgery centers, and subspecialization among pathologists and surgeons. To address these challenges, we developed a novel anatomic pathology hospitalist model with explicit emphasis in frozen section.
Objective.—:
To evaluate our anatomic pathology hospitalist program's impact on (1) frozen section staffing, (2) frozen-permanent diagnostic concordance, and (3) turnaround time.
Design.—:
Frozen section staffing and performance data were collected for the 28-month period spanning July 1, 2021, to October 31, 2023. Outcomes were compared between hospitalists, nonhospitalists, and fellows.
Results.—:
Hospitalists performed more frozen sections per month than nonhospitalists (median, 87 versus 17, respectively; P = .002). After implementation, nonhospitalists' average frozen section staffing obligation fell from 3.7 (30%) of 12.3 total service days per month to 2.8 (22%) of 12.6 total service days per month (P = .005), compared with hospitalists' average of 9.5 frozen section days (69%) of 13.7 total service days per month. Frozen-permanent concordance was marginally but significantly higher for hospitalists (4701 of 4744 blocks, 99.1%) than nonhospitalists (7259 of 7362 blocks, 98.6%; P = .02). Concordance did not correlate with pathologists' academic rank or subspecialization. Turnaround times were comparable for hospitalists, nonhospitalists, and fellows across multiple metrics.
Conclusions.—:
Our anatomic pathology hospitalists significantly reduced the frozen section obligations of nonhospitalist faculty, with a small but significant increase in frozen-permanent concordance and no substantial change in turnaround time.
