Surgical Pathology Case Reviews Before Sign-out: A College of American Pathologists Q-Probes Study of 45 Laboratories‪.‬

Early in training, pathologists are taught to seek the opinion of others when confronted with difficult diagnostic cases. Most pathologists develop particular interest and knowledge in specific organs and tend to seek the advice of others when presented with challenging cases outside this domain of interest and knowledge. Until recently, seeking advice on cases was a voluntary exercise. Recent attention to diagnostic errors in the medical literature and the public press has led to many pathology practices standardizing such case reviews as a plausible measure to prevent errors and to provide assurance of diagnostic accuracy. (1-11) This trend has often been adopted through policies that require second pathologist review of particular types of case. The content of the case review tends to reflect previous specific experience with misdiagnosis in each surgical pathology practice. We report here a Q-Probes study of practices in 45 surgical pathology laboratories that reviewed cases before they were released (review before sign-out). To our knowledge, this is the first study to measure the frequency and characteristics of case review before sign-out in multiple institutions.