AP Discrepancy Rates - College of American Pathologists

Table 4. Number of Specimens and Discrepancy by Organ Type
Change in Change in Change in
Overall Change in Categoric Same Patient Typographic
Specimens, No. Discrepancy, Margin, Interpretation, Category, Information, Error,
Organ
(% of Total) %
%
%
%
%
%
Genital, female
982 (15.9) 7.1 2.3 28.7 36.8 18.4 13.8
Breast
796 (12.9) 8.3 10.9 12.5 42.2 10.9 23.4
Lung
463 (7.5) 5.0 0 13.6 50.0 4.6 31.8
Genital, male
355 (5.7) 7.1 0 41.7 54.1 0
4.2
Soft tissue
345 (5.6) 7.5 0 12.5 66.7 8.3 12.5
Lymph node
288 (4.7) 5.9 5.9 23.5 52.9 0
17.7
Hepatobiliary
240 (3.9) 6.7 0 13.3 53.3 13.3 20.0
Urinary tract
181 (2.9) 7.2 0 30.8 53.9 0
15.4
Pharynx
141 (2.3) 5.0 0 28.6 42.9 0
28.6
Endocrine
125 (2.0) 8.0 0 10.0 50.0 10.0 30.0
Bone marrow
107 (1.7) 6.6 0 14.3 85.7 0
0
Bone
99 (1.6) 2.0 0
0
50.0 0
50.0
Neuropathology
88 (1.4) 6.8 0 16.7 83.3 0
0
Kidney
55 (0.9) 5.5 0 33.3 33.3 0
33.3
Pancreas
31 (0.5) 6.5 0 50.0
0
0
50.0
Salivary gland
29 (0.5) 3.5 0
0 100.0 0
0
Spleen
11 (0.2) 9.1 0
0
0
0 100.0
Gastrointestinal and other
1841 (29.8) 5.6 5.0 19.0 48.0 8.0 20.0
Total 6162 6.7 3.7 21.0 47.7 9.1 18.5
Organ
Genital, female
Breast
Lung
Genital, male
Soft tissue
Lymph node
Hepatobiliary
Urinary tract
Pharynx
Endocrine
Bone marrow
Bone
Neuropathology
Kidney
Pancreas
Salivary gland
Spleen
Gastrointestinal and other
Table 5. Effect of Discrepancy on Patient Management and Pathology Response by Organ Type
Marked
Harm,
%
2.4
1.9
5.3
4.4
8.0
0
0
7.7
0
0
0
0
0
0
0
0
0
0
Moderate
Harm,
%
6.0
7.6
0
0
0
6.2
0
0
0
0
0
0
0
0
0
0
0
2.1
Effect on Patient Outcome
Mild
Harm,
%
16.9
11.3
0
8.7
0
0
7.1
23.1
14.3
0
28.6
0
16.7
0
50.0
0
0
12.6
Near Miss,
%
No Harm,
%
Report Change
Yes, % No, %
462 Arch Pathol Lab Med—Vol 129, April 2005 Patient Safety in Anatomic Pathology—Raab et al
4.8
13.2
21.1
13.0
12.0
18.8
0
7.7
0
11.1
0
0
0
33.3
0
0
0
6.3
69.9
66.0
73.7
73.9
80.0
75.0
92.9
61.5
85.7
88.9
71.4
100.0
83.3
66.7
50.0
100.0
100.0
79.0
58.3
62.3
33.3
56.5
58.3
56.3
42.9
38.5
14.3
33.3
42.9
100.0
50.0
0
100.0
0
100.0
54.1
Total 2.1 3.2 11.3 8.7 7.5 53.3 46.7
report modification in response to a discrepancy (P .15
and P .14, respectively).
In Table 6, the clarity of the report is listed by organ
type. Markedly and moderately unclear reports were seen
infrequently and only in a few specimen types, such as
female genital tract, breast, and lung. Because of the large
number of cells with a value of 0, a 2 goodness-of-fit test
was not performed.
In Table 7, the discrepancy type, original and review
interpretations for categoric discrepancies, and the effect
of the discrepancy on patient outcome are shown. A
change in the same category of diagnosis was the most
common discrepancy detected. For changes in categoric
interpretation, the review diagnosis tended to be shifted
downward to a benign or upward to a malignant diagnosis,
and there were fewer nondefinitive (atypical or sus-
41.7
37.7
66.7
43.5
41.7
43.7
57.1
61.5
85.7
66.7
57.1
0
50.0
100.0
0
100.0
0
45.9
picious) diagnoses compared with the original diagnosis.
When a discrepancy occurred, the most common classification,
based on patient outcome, was a no-harm event.
Anatomic pathology discrepancy specimen-centered
variables, including specimen type and origin, discrepancy
type, primary reason for review, the effect of discrepancy
on patient outcome, and the response to a discrepancy
in the form of a report change, were evaluated
to identify any associations. The statistically significant associations
are shown in Table 8. A request for review directed
by a clinician was much more likely to be associated
with a discrepancy than all other reasons for review. If a
discrepancy occurred, a change in categoric interpretation
was more likely to be seen in cytology specimens compared
with surgical pathology specimens and related to
extradepartmental review compared with all other rea-