Department of Pathology, Baystate Medical Center, Springfield, Massachusetts.
University of Massachusetts Medical School-Baystate, Springfield, Massachusetts.
Cancer Cytopathol. 2018 Dec;126(12):970-979. doi: 10.1002/cncy.22067. Epub 2018 Oct 6.
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.
在之前的社论中，Chapman 和 Otis 在 2011 年，以及 Layfield 在 2014 年总结了许多致力于在外科病理学和细胞病理学中确立关键诊断概念的工作。这两篇社论都以 8 个关键政策要点的列表作为结尾，这些要点是处理和传达关键诊断的有效策略所必需的。我们已经开发并分发了一个基于网络的调查，以了解临床医生对许多关键政策要点的态度，例如应该如何、何时以及向谁报告关键诊断；我们允许在制定沟通政策时与临床人员进行一定程度的合作，正如解剖和外科病理学主任协会（ADASP）的共识声明所建议的那样。我们已经确定了病理学家和临床医生之间在哪些实体应该被认为是关键的以及谁应该负责将组织学发现与更大的临床背景相关联的问题上存在重要的分歧。确定这些不同的观点，并在沟通关键诊断的最佳实践方面促进部门间的协议，是一个重要的患者护理和安全问题。Chapman 和 Otis 还提出了增加获取准确的患者信息和临床病史的重要性，包括对恶性肿瘤的临床怀疑程度，并建立定期审查和质量保证流程。在这里，我们探讨了提高病理学家和细胞病理学家识别意外诊断的能力的方法，包括优化其工作站，以便更好地访问电子病历，并检查自 2012 年 ADASP 共识声明以来外科病理学和细胞病理学中质量保证方法的进展。
