Quantifying the value of in-house consultation in surgical pathology

• Published in: American journal of clinical pathology 2002-05, Vol.117 (5), p.751-754
• Main Authors: RENSHAW, Andrew A, PINNAR, Nat E, JIROUTEK, Michael R, YOUNG, Mary L
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; False Negative Reactions; False Positive Reactions; Female; Hospitals, Private; Humans; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Miscellaneous. Technology; Pathology, Surgical - methods; Pathology. Cytology. Biochemistry. Spectrometry. Miscellaneous investigative techniques; Peer Review, Health Care; Quality Assurance, Health Care; Referral and Consultation; Reproducibility of Results
• ISSN: 0002-9173; 1943-7722
• DOI: 10.1309/RD07-39B9-QN1U-L6U0

In-house consultation is a well-known method to improve diagnostic accuracy and agreement, but the technique has not been well studied. We reviewed the results of in-house consultation in a large private hospital practice setting for a 1-month period and determined its effect on diagnostic accuracy using the final sign-out as the "gold standard." During this 1-month period, 352 cases were reviewed as in-house consultations. Initial complete agreement was found in 315 (89.5%) cases. Using the initial diagnosis as the test case and the final sign-out as the gold standard, of the 37 discrepant cases, 4 (1.1%) were thought to represent false-negative results, (0.3%) a false-positive result, 3 (0.9%) differences in type, and 29 (8.2%) differences in diagnostic threshold. Disagreements in 10 cases were thought to be potentially clinically significant. Internal consultation was obtained on approximately 20% of all cases seen in the laboratory and disagreements were found in 2% of all cases. Internal consultation has a significant and measurable impact on the practice of surgical pathology.