AMENDED REPORTS IN SURGICAL PATHOLOGY AND IMPLICATIONS FOR DIAGNOSTICERROR-DETECTION AND AVOIDANCE - A COLLEGE-OF-AMERICAN-PATHOLOGISTS Q-PROBES STUDY OF 1,667,547 ACCESSIONED CASES IN 359 LABORATORIES

Objectives.-To evaluate amended report rates relative to surveillance methods and to identify surveillance methods or other practice paramet ers that lower amended report rates. Design.-Participants in the 1996 Q-Probes quality improvement program of the College of American Pathol ogists were asked to prospectively document amended surgical pathology reports for a period of 5 months or until 50 amended reports were rec orded. The methods of error detection were also recorded and laborator y and institutional policies surveyed. Four types of amended reports w ere investigated: those issued to correct patient identification error s, to revise originally issued final diagnoses, to revise preliminary written diagnoses, and to revise other reported diagnostic information that was significant with respect to patient management or prognosis. Participants.-Three hundred fifty-nine laboratories, 96% from the Uni ted States. Results.-A total of 3147 amended reports in all four categ ories from a survey of 1 667 547 surgical pathology specimens accessio ned during the study period were issued by the participants. The aggre gate mean rate of amended reports was 1.9 per 1000 cases (median, 1.5 per 1000 cases). Of these, 19.2% were issued to correct patient identi fication errors, 38.7% to change the originally issued final diagnosis , 15.6% to change a preliminary written diagnosis, and 26.5% to change clinically significant information other than the diagnosis. Most fre quently, a request from a clinician to review a case (20.5%) precipita ted the error detection. Although not statistically significant, a hig her amended report rate (1.6 per 1000) for all error types was associa ted with routine diagnostic slide review that was performed after comp letion of the surgical pathology report. This is compared to rates for institutions that had routine diagnostic slide review of cases prior to finalization of pathology reports (1.2 per 1000) and institutions t hat had no routine diagnostic slide review (1.4 per 100). Slide review of cases prior to completion of reports lowered the rate of amended r eports issued for two types of amended reports: those in which the ori ginally issued final diagnosis was changed and those in which informat ion other than the diagnosis was changed for patient management or pro gnostic significance. Other laboratory practice variables examined wer e not found to be associated with the amended report rate. Conclusions .-There is an association between lower amended report rates and diagn ostic slide review of cases prior to completion of the pathology repor t. The level of case review and type of case mix that is necessary for optimal quality assurance needs further investigation.