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