Trends in Extramural Consultation: Comparison between Subspecialized and General Surgical Pathology Service Models

• Published in: Annals of diagnostic pathology Vol. 24; pp. 20 - 24
• Main Authors: Liu, Yong-Jun, MD, PhD, Kessler, Meghan, DO, Zander, Dani S., MD, Karamchandani, Dipti M., MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.10.2016
• Subjects: Extramural consultation; General surgical pathology; Humans; Pathology; Pathology, Clinical - statistics & numerical data; Pathology, Surgical - statistics & numerical data; Referral and Consultation - statistics & numerical data; Retrospective Studies; Sign-out model; Subspecialized surgical pathology; Subspecialized surgical pathology; Sign-out model; General surgical pathology; Extramural consultation
• ISSN: 1092-9134; 1532-8198
• DOI: 10.1016/j.anndiagpath.2016.07.007

Abstract Objectives Academic and community hospital pathology groups are increasingly adopting subspecialized service models for surgical pathology (SP) practice. Reasons cited include improvements in sign-out efficiency, quality and accuracy, enhancement of clinician-pathologist communications, and augmentation of resident training quality. However, there is a paucity of published quantitative data regarding the outcomes of transitioning from general to subspecialized SP service coverage. Methods Retrospective assessment of the frequencies and outcomes of SP extramural consultations requested by faculty at our institution was performed, encompassing two consecutive years each of subspecialized and general SP service models. Results The frequencies of extramural consultations between the two practice models were not significantly different (0.25% vs 0.21%, P=0.142). While more pathology cases were sent out in gastrointestinal (0.29% vs 0.14%, P=0.007), gynecological (0.16% vs 0.02%, P=0.009) and pulmonary (1.73% vs 0.28%, P=0.008) services during the “subspecialization” era, fewer pediatric cases were sent out (0.48% vs 1.69%, P=0.008). Importantly, the transition to the subspecialized model was associated with a marked reduction in the frequency of major disagreements between the original diagnosis and the consultant’s diagnosis (1.8% vs 9.3%, P=0.018). Conclusions Our study supports the value of the subspecialized SP sign-out model for increasing diagnostic accuracy and enhancing the quality of patient care.