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Effectiveness of Random and Focused Review in Detecting Surgical Pathology Error

Stephen S. Raab MD, Dana M. Grzybicki MD, PhD, Laura K. Mahood CT(ASCP), Anil V. Parwani MD, PhD, Shih-Fan Kuan MD, PhD, Uma N. Rao MD
DOI: http://dx.doi.org/10.1309/AJCPPIA5D7MYKDWF 905-912 First published online: 1 December 2008

Abstract

Different error detection methods yield different error proportions and have variable benefits for surgical pathology divisions with limited resources. We performed a nonconcurrent cohort study at a large institution that practices subspecialty surgical pathology sign-out to compare the effectiveness and usefulness of error detection using a targeted 5% random review process and a focused review process. Pathologists reviewed 7,444 cases using a targeted 5% random review process and 380 cases using a focused review process. The numbers of errors detected by the targeted 5% random and focused review processes were 195 (2.6% of reviewed cases) and 50 (13.2%), respectively (P < .001). The numbers of major errors for the targeted 5% random and focused review processes was 27 (0.36%) and 12 (3.2%), respectively (P < .001). Focused review detects a higher proportion of errors and may be more effectively used for design of error reduction initiatives.

Key Words:
  • Medical error
  • Detection methods
  • Quality assurance
  • Surgical pathology