Perspectives and perceptions of urgent and alert values in surgical pathology and cytopathology: A survey of clinical practitioners and pathologists.

In previous editorials, Chapman and Otis in 2011 and Layfield in 2014 have summarized much of the work responsible for establishing the concept of critical diagnoses in surgical pathology and cytopathology. Both editorials end with a list of 8 key policy points needed for an effective strategy of handling and communicating critical diagnoses. We have developed and distributed a Web-based survey to elicit clinicians' attitudes regarding many of those key policy points, such as how, when, and to whom critical diagnoses should be reported; we have allowed some level of collaboration with the clinical staff when developing our communication policies as the Association of Directors of Anatomic and Surgical Pathology (ADASP) consensus statement recommends. We have identified important areas of disagreement between pathologists and clinicians regarding what entities should be considered critical and who should be responsible for correlating histologic findings with the larger clinical context. Identifying these discordant points of view and fostering interdepartmental agreement on the best practices in the communication of critical diagnoses is an important patient care and safety issue. Chapman and Otis have also suggested the importance of increased access to accurate patient information and the clinical history, including the level of clinical suspicion of malignancy, and of forming a periodic review and quality assurance process. Here we explore methods of increasing the ability of pathologists and cytopathologists to identify unexpected diagnoses, including optimization of their workstations for better access to the electronic medical record, and we examine the progress of quality assurance methods in surgical pathology and cytopathology since the ADASP consensus statement in 2012.