CAP TODAY Pathology/Laboratory Medicine/Laboratory Management
Dr. Volk
The committee will propose solutions to the problem of diagnostic error, which the IOM website says may include “clarifying definitions and boundaries; integrating educational approaches; addressing behavioral/cognitive processes and cultural change; teamwork and systems engineering; measures and measurement approaches; research; changes in payment; approaches to medical liability; and health information technology and other technology changes.”
The CAP’s longstanding devotion to excellence in quality improvement “supports efforts to prevent diagnostic errors in all phases of the testing process,” says Emily E. Volk, MD, a member of the CAP Board of Governors and vice chair of the Council on Government and Professional Affairs. “For example, the CAP is committed to patient safety and dedicated to improving the practice of laboratory medicine through rigorous standards and thousands of requirements pathologists and laboratory personnel must meet to achieve CAP accreditation.”
The CAP’s public policies reflect a commitment to patient safety, Dr. Volk adds. For instance, CAP policy urges transparency in reporting errors. Significant errors by a pathologist that have had a negative impact on the prospective health or management of a patient should be discussed first with the physician who ordered the pathology and the two physicians should then jointly determine communication with the patient, the College’s policy says.
The CAP also believes patients should be empowered to understand the laboratory and pathology report and be able to obtain information about pathology results, including second opinions. The quality of clinical laboratory testing rests on the ability of laboratories to replicate each other’s measurements and evaluations, formally through proficiency testing and accreditation programs such as those of the CAP and informally for individual patients through second opinions.
The CAP and the Association of Directors of Anatomic and Surgical Pathology in May announced an evidence-based guideline to provide recommendations for secondary and timely reviews of surgical pathology and cytology cases to improve patient care (see “Evidence drives guideline on reducing interpretive error,” CAP TODAY, July 2015, page 60). The guideline, published in the Archives of Pathology & Laboratory Medicine, provides guidance on how to establish an appropriate secondary review program (Nakhleh RE, et al. Epub ahead of print May 12, 2015. doi:10.5858/arpa.2014-0511-SA).
“Although numerous studies have shown that case reviews help detect interpretive diagnostic errors, there have been no efforts to formalize this practice as a strategy to reduce errors,” the CAP/ADASP guideline says. “In considering processes occurring in surgical pathology and cytology, targeted case reviews could be an integral component of a quality assurance plan that is aimed proactively at preventing errors before they have a potential adverse impact on patient care.”
[hr]Charles Fiegl is CAP manager of advocacy communications, Washington, DC./em>