1
|
Maqsood A, Faheem S, Mirza D, Qayum Z, Lal A, Altamash S, Ahmed N, Heboyan A. An insight into perceptions of general pathologists about the need for oral pathology services: An observational study. SAGE Open Med 2023; 11:20503121231200758. [PMID: 37767537 PMCID: PMC10521304 DOI: 10.1177/20503121231200758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 08/25/2023] [Indexed: 09/29/2023] Open
Abstract
Objective The objective of this study was to identify the degree of perception of oral pathology as a specialty among the general pathologists and the need of utilizing oral pathologists in assisting to identify oral lesions in diagnostic challenges. Methods A questionnaire-based survey was conducted among qualified general pathologists to collect the data. The survey items focused on various aspects, including the analysis of oral pathology as a specialty, the importance of employing oral pathologists for identifying oral lesions in diagnostic challenges, and the difficulties encountered in managing such lesions. The data collected was analyzed using descriptive and inferential statistics. For comparing the relationship between work experience and the referral of odontogenic cysts and tumors cases, a Chi-square test was employed. A significance level of p ⩽ 0.05 was deemed as statistically significant. Results Two hundred and fifty general pathologists responded to the questionnaire. Two hundred and thirty two (92.8%) participants showed awareness of oral pathology as a specialty. For the diagnosis of oral, jaws, and salivary glands pathologic lesions, the majority 198 (79.2%) respondents believed that oral pathologists are required for the diagnosis. Regarding the referrals of lesions to oral pathologists, 137 (54.8%), participants did not refer. In terms of training in oral pathology, all of the participants agreed that they would undertake short-term posting in oral pathology. For challenging cases, all the general pathologists believed that oral pathologists should be part of the team. Conclusion The general pathologists recognized oral pathology as a specialty and feel the need for an oral pathologist opinion in diagnosis. However, most of the general pathologists did not refer the complex cases to oral pathologists. Therefore, it is of paramount importance to encourage oral pathologists and their hiring at histopathology laboratories that are diagnosing complex head and neck cases.
Collapse
Affiliation(s)
- Afsheen Maqsood
- Department of Oral Pathology, Bahria University Dental College, Karachi, Pakistan
| | - Samra Faheem
- Department of Oral Pathology, Bahria University Dental College, Karachi, Pakistan
| | - Daud Mirza
- Department of Oral Pathology, Bahria University Dental College, Karachi, Pakistan
| | - Zahid Qayum
- Department of Oral and Maxillofacial Surgery, Khyber Girls Medical College, Hayatabad Medical Complex, Peshawar, Pakistan
| | - Abhishek Lal
- Department of Prosthodontics, Altamash Institute of Dental Medicine, Karachi, Pakistan
| | - Sara Altamash
- Department of Orthodontics, Altamash Institute of Dental Medicine, Karachi, Pakistan
| | - Naseer Ahmed
- Department of Prosthodontics, Altamash Institute of Dental Medicine, Karachi, Pakistan
| | - Artak Heboyan
- Department of Prosthodontics, Faculty of Stomatology, Yerevan State Medical University after Mkhitar Heratsi, Yerevan, Armenia
| |
Collapse
|
2
|
Johnson SM, Samulski TD, O’Connor SM, Smith SV, Funkhouser WK, Broaddus RR, Calhoun BC. Clinical and Financial Implications of Second-Opinion Surgical Pathology Review. Am J Clin Pathol 2021; 156:559-568. [PMID: 33769453 DOI: 10.1093/ajcp/aqaa263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Second-opinion pathology review identifies clinically significant diagnostic discrepancies for some patients. Discrepancy rates and laboratory-specific costs in a single health care system for patients referred from regional affiliates to a comprehensive cancer center ("main campus") have not been reported. METHODS Main campus second-opinion pathology cases for 740 patients from eight affiliated hospitals during 2016 to 2018 were reviewed. Chart review was performed to identify changes in care due to pathology review. To assess costs of pathology interpretation, reimbursement rates for consultation Current Procedural Terminology billing codes were compared with codes that would have been used had the cases originated at the main campus. RESULTS Diagnostic discrepancies were identified in 104 (14.1%) patients, 30 (4.1%) of which resulted in a change in care. In aggregate, reimbursement for affiliate cases was 65.6% of the reimbursement for the same cases had they originated at the main campus. High-volume organ systems with low relative consultation reimbursement included gynecologic, breast, and thoracic. CONCLUSIONS Preventable diagnostic errors are reduced by pathology review for patients referred within a single health care system. Although the resulting changes in care potentially lead to overall cost savings, the financial value of referral pathology review could be improved.
Collapse
Affiliation(s)
- Steven M Johnson
- Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Teresa D Samulski
- Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Siobhan M O’Connor
- Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Scott V Smith
- Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - William K Funkhouser
- Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Russell R Broaddus
- Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Benjamin C Calhoun
- Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| |
Collapse
|
3
|
Macon WR. A radiology survey and sub-sub-specialization in hematopathology. J Hematop 2021. [DOI: 10.1007/s12308-021-00444-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
|
4
|
Jensen KJ, Stallone R, Eller M, Castagnaro J, Poczter H, Tesoriero R, Balzano-Kane J, Gusman C, Bhuiya T, Breining D, Crawford JM. Northwell Health Laboratories: The 10-Year Outcomes After Deciding to Keep the Lab. Arch Pathol Lab Med 2019; 143:1517-1530. [PMID: 31100013 DOI: 10.5858/arpa.2018-0569-sa] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Northwell Health Laboratories were established in 1997, serving the Northwell Health system. In 2008, the health system considered minority entry into a joint venture with a commercial laboratory. Based on arguments made by Northwell laboratory leadership, the decision was made to retain full ownership of the laboratory. OBJECTIVE.— To evaluate the 10-year outcomes of the 2008 decision and assess the value of a fully integrated laboratory service line for a regional health network. DESIGN.— Ten-year outcomes were analyzed including financial, volume, and value-based activities. RESULTS.— First, a fully integrated laboratory service line was created, with unified medical and managerial leadership. Second, Core Laboratory volumes and revenues grew at annualized rates of 4.5% and 16.0%, respectively. Third, hospital-based laboratory costs were held either constant, or grew in accordance with strategic clinical programs. Fourth, laboratory services were able to provide leadership in innovative system clinical programming and value-based payment programs. Fifth, the laboratories became a regional asset, forming a joint venture affiliation with New York City Health + Hospitals, and supporting distressed hospitals in Brooklyn, New York. Lastly, Northwell Health Laboratories have become a reputational asset through leadership in 2 consortia: The Compass Group and Project Santa Fe. CONCLUSIONS.— The 10-year outcomes have exceeded projections made in 2008, validating the decision to retain the laboratories as a wholly owned system asset. The laboratories are now well positioned for leading innovation in patient care and for helping to drive a favorable posture for the health system under new payment models for health care.
Collapse
Affiliation(s)
- Kendal J Jensen
- Department of Pathology and Laboratory Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Robert Stallone
- Department of Pathology and Laboratory Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Michael Eller
- Department of Pathology and Laboratory Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Joseph Castagnaro
- Department of Pathology and Laboratory Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Hannah Poczter
- Department of Pathology and Laboratory Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Richard Tesoriero
- Department of Pathology and Laboratory Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Jeanne Balzano-Kane
- Department of Pathology and Laboratory Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Cari Gusman
- Department of Pathology and Laboratory Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Tawfiqul Bhuiya
- Department of Pathology and Laboratory Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Dwayne Breining
- Department of Pathology and Laboratory Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - James M Crawford
- Department of Pathology and Laboratory Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| |
Collapse
|
5
|
Alhindi NA, Sindi AM, Binmadi NO, Elias WY. A retrospective study of oral and maxillofacial pathology lesions diagnosed at the Faculty of Dentistry, King Abdulaziz University. Clin Cosmet Investig Dent 2019; 11:45-52. [PMID: 30881140 PMCID: PMC6404671 DOI: 10.2147/ccide.s190092] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Oral and maxillofacial lesions (OMFL) comprise a broad spectrum of benign and malignant lesions that affect the oral cavity. However, few epidemiological studies have evaluated oral cavity lesions, and very few have focused on oral soft tissue pathology. The purpose of this study was to identify the prevalence and distribution of OMFL that had been diagnosed histologically at the Oral Pathology Laboratory, Faculty of Dentistry, King Abdulaziz University. Materials and methods A retrospective study was conducted to assess the distribution of OMFL among the oral cavity biopsies submitted to the Oral Pathology Laboratory during the period from 1996 to 2016. Information on sex, age, location of the lesion, and histopathologic diagnosis was analyzed. Results A total of 1,218 cases were examined. Among these, reactive/adaptive lesions were the most common type (n=245; 20.1%) and cystic lesions were the second most common (n=214; 17.6%), followed by inflammatory lesions (n=152; 12.5%) and epithelial pathology (n=115; 9.4%). Conclusion The results of the present study provide valuable information on the prevalence of OMFL in Jeddah, Saudi Arabia. Reactive conditions were the most frequently diagnosed pathologies. Most oral and maxillofacial biopsies were soft tissue lesions, benign in nature, and inflammatory in origin. Further studies are necessary to provide more information on head and neck diseases in the general population to develop better future oral health policies.
Collapse
Affiliation(s)
- Nada A Alhindi
- Oral Diagnostic Science Department, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia,
| | - Amal M Sindi
- Oral Diagnostic Science Department, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia,
| | - Nada O Binmadi
- Oral Diagnostic Science Department, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia,
| | - Wael Y Elias
- Oral Diagnostic Science Department, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia,
| |
Collapse
|
6
|
Binmadi NO, Almazrooa SA. The use of oral and maxillofacial pathology services by general pathologists and their attitude towards it in Saudi Arabia. Saudi Med J 2017; 38:857-862. [PMID: 28762440 PMCID: PMC5556304 DOI: 10.15537/smj.2017.8.18084] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To investigate the awareness and usage of oral and maxillofacial pathology (OMFP) subspecialty services among pathologists in Saudi Arabia. Methods: In this cross-sectional study, we conducted an electronic questionnaire survey of pathologists in all regions of Saudi Arabia. The study was conducted between July 2015 and August 2016. The questionnaire comprised 19 questions to evaluate the knowledge of pathologists regarding microscopic OMFP and their perceptions towards this subspecialty. Results: Most of the pathologists surveyed (94.6%) were aware of the OMFP subspecialty and its scope of practice. Although most of the pathologists recognized the importance and need of this subspecialty, 70% of them never referred or consulted an oral pathologist as they either diagnosed the cases themselves or did not know any oral pathologist (57.7%). The pathologists had the greatest difficulty in identifying and diagnosing odontogenic tumors, salivary gland tumors, and odontogenic cysts. Conclusion: Pathologists are aware of the OMFP subspecialty, but their utilization of the services offered by OMFP specialists in Saudi Arabia is quite low despite the strong demand for OMFP services.
Collapse
Affiliation(s)
- Nada O Binmadi
- Department Oral Diagnostic Sciences, Faculty of Dentistry, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia. E-mail.
| | | |
Collapse
|
7
|
Conant JL, Gibson PC, Bunn J, Ambaye AB. Transition to Subspecialty Sign-Out at an Academic Institution and Its Advantages. Acad Pathol 2017; 4:2374289517714767. [PMID: 28815203 PMCID: PMC5528966 DOI: 10.1177/2374289517714767] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Many pathology departments are introducing subspecialty sign-out in surgical pathology. In 2014, the University of Vermont Medical Center transitioned from general sign-out to partial subspecialty sign-out to include gastrointestinal and breast/cervix subspecialty benches; other specimens remained on general benches. Our experiences with the transition are described, including attending pathologist, trainee, support staff, and clinician satisfaction. A survey was e-mailed to all University of Vermont Medical Center anatomic pathology attendings, pathology trainees, pathologist assistants and grossing technicians, and clinicians who send surgical pathology specimens, immediately before and 1 year after transitioning to partial subspecialty sign-out. Quality assurance metrics were obtained for the 18 months prior to and following the transition. Gastrointestinal and breast/cervix attendings were more satisfied with partial subspecialty sign-out compared to those on the general benches. Overall, trainees were more satisfied with general sign-out because of the rotation schedule but preferred partial subspecialty sign-out due to improved teaching and more focused learning while on subspecialty benches. Clinicians remained very satisfied with our department and our reports; no differences were observed. Turnaround time was unchanged. After switching to partial subspecialty sign-out, there were significantly fewer discrepancies following multidisciplinary conference review for gastrointestinal and breast/cervix cases but remained the same for general cases. Fewer formal internal consults were performed after transitioning to partial subspecialty sign-out across all areas, but more notable for gastrointestinal and breast/cervix cases. Our data show improved quality assurance metrics and trainee education in a subspecialty sign-out setting compared to general sign-out setting.
Collapse
Affiliation(s)
- Joanna L Conant
- Department of Pathology and Laboratory Medicine, University of Vermont Medical Center, Burlington, VT, USA
| | - Pamela C Gibson
- Department of Pathology and Laboratory Medicine, University of Vermont Medical Center, Burlington, VT, USA
| | - Janice Bunn
- Department of Pathology and Laboratory Medicine, University of Vermont Medical Center, Burlington, VT, USA
| | - Abiy B Ambaye
- Department of Pathology and Laboratory Medicine, University of Vermont Medical Center, Burlington, VT, USA
| |
Collapse
|
8
|
Khalifa MA, Salama S, Vogel RI, Klein ME, Richter J, Pulver T, Mullany SA, Winterhoff B. Assessment of the Intraoperative Consultation Service Rendered by General Pathologists in a Scenario Where a Well-Defined Decision Algorithm Is Followed. Am J Clin Pathol 2017; 147:322-326. [PMID: 28395052 DOI: 10.1093/ajcp/aqw223] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Intraoperative consultation (IOC) remains an area of general practice even within subspecialized pathology departments. This study assesses the IOCs rendered in a general pathology setting where surgeons integrate these results in a well-defined algorithm, developed with the input of specialized pathologists. METHODS The surgical decisions to perform lymphadenectomy in patients with endometrial adenocarcinoma operated on at our institution between January 2003 and June 2015 as a result of the IOC assessment of tumor size, histologic grade, and depth of invasion in the hysterectomy specimen were analyzed. RESULTS Frozen section (FS) was examined in 801 cases. In comparison to permanent section analysis, FS International Federation of Gynecology and Obstetrics (FIGO) grade had an overall accuracy of 0.95 (95% confidence interval [CI], 0.93-0.98). The FS depth of invasion had an overall accuracy of 0.92 (95% CI, 0.89-0.94). FIGO grade was not documented in 47.8%, the depth of myometrial invasion in 45.2%, and tumor size in 41.8% of the pathology reports. CONCLUSIONS The high omission rate of the needed parameters by the general pathologists would question their overall understanding of the paradigm shift intended by this algorithm. Possible explanations of this phenomenon and potential solutions are discussed.
Collapse
Affiliation(s)
| | - Sherine Salama
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
| | - Rachel I Vogel
- Department of Obstetrics, Gynecology and Women's Health, Division of Gynecologic Oncology, University of Minnesota, Minneapolis
| | - Molly E Klein
- From the Department of Laboratory Medicine and Pathology
| | - James Richter
- From the Department of Laboratory Medicine and Pathology
| | - Tanya Pulver
- Department of Obstetrics, Gynecology and Women's Health, Division of Gynecologic Oncology, University of Minnesota, Minneapolis
| | - Sally A Mullany
- Department of Obstetrics, Gynecology and Women's Health, Division of Gynecologic Oncology, University of Minnesota, Minneapolis
| | - Boris Winterhoff
- Department of Obstetrics, Gynecology and Women's Health, Division of Gynecologic Oncology, University of Minnesota, Minneapolis
| |
Collapse
|
9
|
Balfour E, Stallone R, Castagnaro J, Poczter H, Schron D, Martone J, Breining D, Simpkins H, Neglia T, Kalish P, Crawford JM. Strengths of the Northwell Health Laboratory Service Line: Maintaining Performance During Threatened Interruptions in Service. Acad Pathol 2016; 3:2374289516650961. [PMID: 28725768 PMCID: PMC5497918 DOI: 10.1177/2374289516650961] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 04/14/2016] [Accepted: 04/28/2016] [Indexed: 11/30/2022] Open
Abstract
From 2009 to 2015, the laboratories of the 19-hospital North Shore-LIJ Health System experienced 5 threatened interruptions in service and supported 2 regional health-care providers with threatened interruptions in their laboratory service. We report our strategies to maintain laboratory performance during these events, drawing upon the strengths of our integrated laboratory service line. Established in 2009, the laboratory service line has unified medical and administrative leadership and system-wide divisional structure, quality management, and standardization of operations and procedures. Among many benefits, this governance structure enabled the laboratories to respond to a series of unexpected events. Specifically, at our various service sites, the laboratories dealt with pandemic (2009), 2 floods (2010, 2012), 2 fires (2010, 2015), and laboratory floor subsidence (2013). We were also asked to provide support for a regional physician network facing abrupt loss of testing services from closure of another regional clinical laboratory (2010) and to intervene for a non-health system hospital threatened with closure owing to noncompliance of laboratory operations (2012). In all but a single instance, patient care was served without interruption in service. In the last instance, fire interrupted laboratory services for 30 minutes. We conclude that in a large integrated health system, threats to continuous laboratory operations are not infrequent when measured on an annual basis. While most threats are from external physical circumstances, some emanate from unexpected administrative events. A strong laboratory governance mechanism that includes unified medical and administrative leadership across the entirety of the laboratory service line enables successful responses to these threats.
Collapse
Affiliation(s)
- Erika Balfour
- Department of Pathology and Cell Biology, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Robert Stallone
- Department of Pathology and Laboratory Medicine, Hofstra Northwell School of Medicine, Manhasset, NY, USA
| | - Joseph Castagnaro
- Department of Pathology and Laboratory Medicine, Hofstra Northwell School of Medicine, Manhasset, NY, USA
| | - Hannah Poczter
- Department of Pathology and Laboratory Medicine, Hofstra Northwell School of Medicine, Manhasset, NY, USA
| | - Deborah Schron
- Department of Pathology and Laboratory Medicine, Hofstra Northwell School of Medicine, Manhasset, NY, USA
| | - James Martone
- Department of Pathology and Laboratory Medicine, Hofstra Northwell School of Medicine, Manhasset, NY, USA
| | - Dwayne Breining
- Department of Pathology and Laboratory Medicine, Hofstra Northwell School of Medicine, Manhasset, NY, USA
| | - Henry Simpkins
- Department of Pathology and Laboratory Medicine, Hofstra Northwell School of Medicine, Manhasset, NY, USA
| | - Tom Neglia
- Department of Pathology and Laboratory Medicine, Hofstra Northwell School of Medicine, Manhasset, NY, USA
| | - Paul Kalish
- Department of Pathology and Laboratory Medicine, Hofstra Northwell School of Medicine, Manhasset, NY, USA.,Deceased
| | - James M Crawford
- Department of Pathology and Laboratory Medicine, Hofstra Northwell School of Medicine, Manhasset, NY, USA
| |
Collapse
|
10
|
Hartman DJ. Enhancing and Customizing Laboratory Information Systems to Improve/Enhance Pathologist Workflow. Clin Lab Med 2016; 36:31-9. [PMID: 26851662 DOI: 10.1016/j.cll.2015.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Optimizing pathologist workflow can be difficult because it is affected by many variables. Surgical pathologists must complete many tasks that culminate in a final pathology report. Several software systems can be used to enhance/improve pathologist workflow. These include voice recognition software, pre-sign-out quality assurance, image utilization, and computerized provider order entry. Recent changes in the diagnostic coding and the more prominent role of centralized electronic health records represent potential areas for increased ways to enhance/improve the workflow for surgical pathologists. Additional unforeseen changes to the pathologist workflow may accompany the introduction of whole-slide imaging technology to the routine diagnostic work.
Collapse
Affiliation(s)
- Douglas J Hartman
- Department of Anatomic Pathology, University of Pittsburgh Medical Center, 200 Lothrop Street, A-607, Pittsburgh, PA 15213, USA.
| |
Collapse
|
11
|
Rishi A, Hoda ST, Crawford JM. A Required Rotation in Clinical Laboratory Management for Pathology Residents: Five-Year Experience at Hofstra Northwell School of Medicine. Acad Pathol 2016; 3:2374289516644621. [PMID: 28725766 PMCID: PMC5497904 DOI: 10.1177/2374289516644621] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 03/17/2016] [Accepted: 03/18/2016] [Indexed: 11/29/2022] Open
Abstract
Leadership and management training during pathology residency have been identified repeatedly by employers as insufficient. A 1-month rotation in clinical laboratory management (CLM) was created for third-year pathology residents. We report on our experience and assess the value of this rotation. The rotation was one-half observational and one-half active. The observational component involved being a member of department and laboratory service line leadership, both at the departmental and institutional level. Observational participation enabled learning of both the content and principles of leadership and management activities. The active half of the rotation was performance of a project intended to advance the strategic trajectory of the department and laboratory service line. In our program that matriculates 4 residents per year, 20 residents participated from April 2010 through December 2015. Their projects either activated a new priority area or helped propel an existing strategic priority forward. Of the 16 resident graduates who had obtained their first employment or a fellowship position, 9 responded to an assessment survey. The majority of respondents (5/9) felt that the rotation significantly contributed to their ability to compete for a fellowship or their first employment position. The top reported benefits of the rotation included people management; communication with staff, departmental, and institutional leadership; and involvement in department and institutional meetings and task groups. Our 5-year experience demonstrates both the successful principles by which the CLM rotation can be established and the high value of this rotation to residency graduates.
Collapse
Affiliation(s)
- Arvind Rishi
- Department of Pathology and Laboratory Medicine, Hofstra Northwell School of Medicine, Lake Success, NY, USA
| | - Syed T Hoda
- NYU Langone Medical Center, New York, NY, USA
| | - James M Crawford
- Department of Pathology and Laboratory Medicine, Hofstra Northwell School of Medicine, Lake Success, NY, USA
| |
Collapse
|
12
|
Robboy SJ, Gupta S, Crawford JM, Cohen MB, Karcher DS, Leonard DGB, Magnani B, Novis DA, Prystowsky MB, Powell SZ, Gross DJ, Black-Schaffer WS. The Pathologist Workforce in the United States: II. An Interactive Modeling Tool for Analyzing Future Qualitative and Quantitative Staffing Demands for Services. Arch Pathol Lab Med 2016; 139:1413-30. [PMID: 26516939 DOI: 10.5858/arpa.2014-0559-oa] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT Pathologists are physicians who make diagnoses based on interpretation of tissue and cellular specimens (surgical/cytopathology, molecular/genomic pathology, autopsy), provide medical leadership and consultation for laboratory medicine, and are integral members of their institutions' interdisciplinary patient care teams. OBJECTIVE To develop a dynamic modeling tool to examine how individual factors and practice variables can forecast demand for pathologist services. DESIGN Build and test a computer-based software model populated with data from surveys and best estimates about current and new pathologist efforts. RESULTS Most pathologists' efforts focus on anatomic (52%), laboratory (14%), and other direct services (8%) for individual patients. Population-focused services (12%) (eg, laboratory medical direction) and other professional responsibilities (14%) (eg, teaching, research, and hospital committees) consume the rest of their time. Modeling scenarios were used to assess the need to increase or decrease efforts related globally to the Affordable Care Act, and specifically, to genomic medicine, laboratory consolidation, laboratory medical direction, and new areas where pathologists' expertise can add value. CONCLUSIONS Our modeling tool allows pathologists, educators, and policy experts to assess how various factors may affect demand for pathologists' services. These factors include an aging population, advances in biomedical technology, and changing roles in capitated, value-based, and team-based medical care systems. In the future, pathologists will likely have to assume new roles, develop new expertise, and become more efficient in practicing medicine to accommodate new value-based delivery models.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - W Stephen Black-Schaffer
- From the Department of Pathology, Duke University Medical Center, Durham, North Carolina (Dr Robboy); The Smart Cube, Noida, India (Mr Gupta); the Department of Pathology and Laboratory Medicine, North Shore-Long Island Jewish Health System, Manhasset, New York (Dr Crawford); the Department of Pathology, Huntsman Cancer Hospital, University of Utah, Salt Lake City (Dr Cohen); the Department of Pathology, George Washington University, Washington, DC (Dr Karcher); the Department of Pathology, University of Vermont College of Medicine, Burlington (Dr Leonard); the Department of Pathology, Tufts University School of Medicine, Boston, Massachusetts (Dr Magnani); Novis Consulting, Lee, New Hampshire (Dr Novis); the Department of Pathology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York (Dr Prystowsky); the Department of Pathology and Genomic Medicine, The Methodist Hospital, Houston, Texas (Dr Powell); Policy Roundtable, College of American Pathologists, Washington, DC (Dr Gross); the Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston (Dr Black-Schaffer)
| |
Collapse
|
13
|
Hartman DJ. Enhancing and Customizing Laboratory Information Systems to Improve/Enhance Pathologist Workflow. Surg Pathol Clin 2015; 8:137-43. [PMID: 26065788 DOI: 10.1016/j.path.2015.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Optimizing pathologist workflow can be difficult because it is affected by many variables. Surgical pathologists must complete many tasks that culminate in a final pathology report. Several software systems can be used to enhance/improve pathologist workflow. These include voice recognition software, pre-sign-out quality assurance, image utilization, and computerized provider order entry. Recent changes in the diagnostic coding and the more prominent role of centralized electronic health records represent potential areas for increased ways to enhance/improve the workflow for surgical pathologists. Additional unforeseen changes to the pathologist workflow may accompany the introduction of whole-slide imaging technology to the routine diagnostic work.
Collapse
Affiliation(s)
- Douglas J Hartman
- Department of Anatomic Pathology, University of Pittsburgh Medical Center, 200 Lothrop Street, A-607, Pittsburgh, PA 15213, USA.
| |
Collapse
|
14
|
Modeling complexity in pathologist workload measurement: the Automatable Activity-Based Approach to Complexity Unit Scoring (AABACUS). Mod Pathol 2015; 28:324-39. [PMID: 25216230 DOI: 10.1038/modpathol.2014.123] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 07/07/2014] [Accepted: 07/08/2014] [Indexed: 11/09/2022]
Abstract
Pathologists provide diagnoses relevant to the disease state of the patient and identify specific tissue characteristics relevant to response to therapy and prognosis. As personalized medicine evolves, there is a trend for increased demand of tissue-derived parameters. Pathologists perform increasingly complex analyses on the same 'cases'. Traditional methods of workload assessment and reimbursement, based on number of cases sometimes with a modifier (eg, the relative value unit (RVU) system used in the United States), often grossly underestimate the amount of work needed for complex cases and may overvalue simple, small biopsy cases. We describe a new approach to pathologist workload measurement that aligns with this new practice paradigm. Our multisite institution with geographically diverse partner institutions has developed the Automatable Activity-Based Approach to Complexity Unit Scoring (AABACUS) model that captures pathologists' clinical activities from parameters documented in departmental laboratory information systems (LISs). The model's algorithm includes: 'capture', 'export', 'identify', 'count', 'score', 'attribute', 'filter', and 'assess filtered results'. Captured data include specimen acquisition, handling, analysis, and reporting activities. Activities were counted and complexity units (CUs) generated using a complexity factor for each activity. CUs were compared between institutions, practice groups, and practice types and evaluated over a 5-year period (2008-2012). The annual load of a clinical service pathologist, irrespective of subspecialty, was ∼40,000 CUs using relative benchmarking. The model detected changing practice patterns and was appropriate for monitoring clinical workload for anatomical pathology, neuropathology, and hematopathology in academic and community settings, and encompassing subspecialty and generalist practices. AABACUS is objective, can be integrated with an LIS and automated, is reproducible, backwards compatible, and future adaptable. It can be applied as a robust decision support tool for the assessment of overall and targeted staffing needs as well as utilization analyses for resource allocation.
Collapse
|
15
|
Guarner J. Incorporating Pathology in the Practice of Infectious Disease: Myths and Reality. Clin Infect Dis 2014; 59:1133-41. [DOI: 10.1093/cid/ciu469] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
|
16
|
|