Addenda in pathology reports: trends and their implications.

Addenda are typically used to report results of additional studies that are delayed relative to histopathologic studies. However, the frequency and pattern of use of addenda have not been previously reported. We studied the dynamics of addenda creation within the same month at 5-year intervals during a 15-year period at our institution. The number of addenda and type and impact of information communicated in addenda were assessed in the month of July in 1993, 1998, 2003, and 2008, and the possible role of addenda in quality improvement was evaluated. Cases with addenda increased from 0.9% in 1993 to 8.6% in 2008. In 5.6% of addenda, there was information that might have been better reported in an amendment, suggesting that criteria for amendments need to be universally implemented. Charting trends and types of addenda offered opportunities for quality improvement by identifying weaknesses in the workflow organization of the laboratory. Pathologists are under pressure to issue reports as soon as possible, to allay patient apprehension about the diagnosis and to allow for rapid triage of patients for appropriate clinical management. This is somewhat at odds with changes in the practice of pathology, with specific requirements for specimen fixation and an ever-increasing array of ancillary tests required for a full and proper evaluation of a specimen. Pathologists therefore sometimes issue final reports with a primary “histologic” diagnosis and submit the results of supplementary tests as addenda at a later date. On occasion, results of these ancillary studies may not only add data to the originally issued report but also add information that modifies the original histopathologic interpretation. In this setting, another option available to pathologists is to amend the report. However, traditionally, amendments have been reserved for significant corrections to previously issued pathology reports. Amendments are considered a measure of a “defect” in the diagnostic system1-3 and are tracked as part of institutional quality assurance programs.4 Given the lack of universally accepted guidelines about distinction between the two and the natural reluctance of pathologists toward amendments, the addendum is often favored over an amendment by many pathologists. Yet, transmitting important information as simple additional facts may create a deceptively low profile for significant results and could reduce the effectiveness of the final report in communicating critical information to treating physicians. To determine the role of the addendum in the communication of pathology information, we studied the rate and dynamics of addenda creation within the same monthly period at 5-year intervals during a 15-year period. We also evaluated the type, timing, and impact of information communicated in addenda and tried to determine the role, if any, of using this information for quality improvement. by gest on A uust 2, 2016 http://ajcordjournals.org/ D ow nladed from