Secondary Case Review Methods and Anatomic Pathology Culture

Abstract

In this issue of the Journal , Owens and colleagues1 at the University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, describe the development of a patient safety information technology (IT) tool. Because this tool only recently has been implemented, Owens et al1 chose not to evaluate the effectiveness of the tool as a patient safety improvement initiative and preferred to evaluate the tool on its effect on timeliness, another Institute of Medicine (IOM) quality metric.2 The work of Owens et al1 highlights the relationship of patient safety to other quality domains, error detection, and quality improvement in surgical pathology. The IOM defined 6 domains of quality: safety, effectiveness, efficiency, timeliness, equity, and patient centeredness.2 During the past several decades, most of the published work in the anatomic pathology medical literature has focused on the domains of safety and timeliness. The 6 quality domains are not independent, as illustrated by the data reported by Owens et al.1 For many surgical pathologists, the mantra has become “get it right and get it (out) fast,” and efforts to change a specific practice domain (eg, safety) may lead to unforeseen changes in other domains (eg, timeliness). The fact that Owens et al1 measured turnaround time indicated that they were concerned that possible delays in case sign-out may have occurred because of newly introduced processes. Owens et al1 reported a slight increase in median case turnaround time following implementation of their patient safety IT tool. Outlier analysis was not performed, which possibly is a more important measure. Barriers to improve a specific quality metric are many and include the lack of organizational commitment or focus and investment in competing quality metrics. Organizational culture strongly affects the ability of front-line personnel to improve health care delivery, especially safe …