Evaluation and Reduction of Diagnostic Errors in Pathology Using an Evidence-Based Approach

Abstract

A substantial proportion of patients’ diagnoses and treatments are dependent on reliable tissue diagnoses in surgical pathology and cytopathology. In cancer management, tissue diagnosis and staging are the most important determinants of prognosis and therapy. Likewise, determining the level of rejection in allograft biopsies is the main determinant of immunosuppressive therapy. The importance of a correct diagnosis in these situations cannot be overemphasized. In attempting to reduce errors many advocate a systems approach. In this scheme of error reduction a handful of reasons are cited as the primary causes of errors. They include lack of communication, variable input, complexity, inconsistency, human intervention, tight time constraints and a hierarchical culture. The literature on pathology errors is far from comprehensive and has not for the most part taken this approach but does offer clues of how errors occur and how they could be addressed. In this chapter, the author discusses how errors occur in surgical pathology and then attempts to adapt to pathology existing proven knowledge used in many industries to reduce errors.