Xing Juan, Seigh Lindsey, Monaco Sara E, Ohori N Paul, Yousem Samuel A, Amin Rajnikant, Pantanowitz Liron
Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Cancer Cytopathol. 2017 Sep;125(9):726-730. doi: 10.1002/cncy.21896. Epub 2017 Jul 13.
Critical values have been well established and accepted in laboratory medicine, but to the authors' knowledge are less well accepted in anatomic pathology. Herein, the authors used a reporting process whereby reports with critical diagnoses were coded to ensure that the patient's clinical team was promptly notified electronically of this finding. The aim of the current study was to determine whether this coding mechanism was used appropriately for critical cytopathology diagnoses in the study health care system.
A retrospective review of the University of Pittsburgh Medical Center anatomic pathology laboratory information system was performed to identify cytopathology reports in which a critical diagnosis code (MedTrak notification/CoPath Tissue Code TC66; TC66) was used from 2011 through 2016. TC66-coded cytopathology reports between 2015 and 2016 were reviewed further to determine whether this code was used appropriately.
A total of 1687 TC66-coded cytopathology reports were identified. Between 2015 and 2016, a total of 30 of 46 reports (65%) from academic hospitals and 46 of 441 reports (10%) from community hospitals met the critical diagnoses criteria outlined by institutional policy. The remaining TC66-coded cases were predominantly for new diagnoses of malignancy in patients clinically suspected of having cancer.
Use of a code for critical cytopathology diagnoses was found to be occurring increasingly at the study health care system. Pathologists at the academic and community hospitals in the study institution used this code somewhat differently, reflecting the need to satisfy communication with clinicians in different practice settings. Nevertheless, the authors' experiences with using a code for critical diagnoses not only ensured timely patient care but also proposed a model that could be used by other medical specialties to enhance communication and improve quality of care. Cancer Cytopathol 2017;125:726-30. © 2017 American Cancer Society.
危急值在检验医学中已得到充分确立和认可，但据作者所知，在解剖病理学中其认可度较低。在此，作者采用了一种报告流程，即对具有危急诊断的报告进行编码，以确保患者的临床团队能迅速收到该检查结果的电子通知。本研究的目的是确定在该研究医疗系统中，这种编码机制是否适用于危急细胞病理学诊断。
对匹兹堡大学医学中心解剖病理学实验室信息系统进行回顾性分析，以识别2011年至2016年期间使用危急诊断代码（MedTrak通知/CoPath组织代码TC66；TC66）的细胞病理学报告。对2015年至2016年期间编码为TC66的细胞病理学报告进行进一步审查，以确定该代码的使用是否恰当。
共识别出1687份编码为TC66的细胞病理学报告。2015年至2016年期间，学术医院的46份报告中有30份（65%），社区医院的441份报告中有46份（10%）符合机构政策规定的危急诊断标准。其余编码为TC66的病例主要是临床怀疑患有癌症患者的恶性肿瘤新诊断。
在该研究医疗系统中，用于危急细胞病理学诊断的代码使用越来越频繁。该研究机构学术医院和社区医院的病理学家对该代码的使用略有不同，这反映了在不同实践环境中与临床医生沟通的需求。尽管如此，作者使用危急诊断代码的经验不仅确保了及时的患者护理，还提出了一种可供其他医学专业使用的模式，以加强沟通并提高护理质量。《癌症细胞病理学》2017年；125：726 - 30。©2017美国癌症协会。
