[Histonet] outside review.

[Tench, Bill]

I thought I sent this yesterday, but it didn't address properly.  I
guess things are different in my part of the world in terms of the
frequency of this activity compared with others.  Please see the rest.

The policy/procedure requiring review of outside slides before
definitive treatment (including surgery, radiation therapy, or
chemotherapy) in another institution is a fairly common but frequently
unenforced policy in many hospitals other than academic institutions.
The policy may reside in the Pathology Dept, Surgery Dept, or more
frequently (and safely) as a standard Hospital policy.  Typically,
enforceability is improved if the policy is a Hospital policy.  There is
an ever growing body of evidence that this policy benefits the patient,
the hospital, the clinician, and the pathologist.  Compliance is always
an issue, especially outside of academic centers, who, out of a belief
that the community pathologists are prone to mistakes that academic
centers never make, insist on review before treatment.  "Everyone's
benefit" is always a nice "carrot," but unfortunately, without a
"stick," compliance may be a challenge.  For the surgeons, at least, the
risk of cancellation of the case if a TIMELY request for outside review
has not been made serves as a useful "stick," the application of which
should be applied judiciously (and perhaps with a flack jacket).
Radiation and Chemo cases require either: 1) cooperation of these
departments  or 2) external review of all cases treated in those
departments to determine whether or not case review has occurred.  The
goal is to, as best as possible, confirm the diagnosis as well as other
aspects that may have an impact on the appropriate therapy, and to do so
without significant delay in the patient's care.  Anything that makes
the process easier is a good idea.  In my system, the responsibility of
the treating physician is to fax to the pathology dept a copy of the
report when they have decided to proceed with additional treatment
(surgery, rads, etc), and the pathology dept does all the work
associated with requesting the slides and insuring a timely review.  We
advise (and continuously train) the outside office staff that they must
provide us this information ASAP because some outside institutions are
woefully slow in sending the material to us. (For requests to us from
other institutions, we typically send the material to the requesting
institution within 24 hours if we don't have to prepare recuts. We
re-review all material going elsewhere, and we only send original slides
if we have multiple representative levels in our file or we have very
limited material-like FNA's, otherwise we recut the case).

 

Dr Bill Tench

Assoc Dir. Lab Services

Chief Cytology

Palomar Medical Center

555 E. Valley Parkway

Escondido, Ca 92025

Voice: 760-739-3037

Fax:  760-739-2604

 


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