How effective is intraoperative communication in Winnipeg hospitals? a comparison of intraoperative diagnoses listed in pathology reports and operative notes
Loading...
Date
2019-11-15
Authors
Moodie, Amanda
Journal Title
Journal ISSN
Volume Title
Publisher
Abstract
Background: Diagnoses rendered during intraoperative consultations are acted on immediately and are highly dependent on verbal interactions between the pathologist and surgeon. Clear and efficient communication between the operating and diagnostic teams is critical in this setting, since any miscommunication may have an irreversible impact on patient care.
Design: We examined the concordance of intraoperative diagnoses recorded in pathology reports to surgeon-dictated operative notes as a result of verbal communications. Discrepancies between the intended communication by the pathologists and the interpretation by the surgeons were categorized by potential clinical impact: minor if the overall diagnoses were correct but contained minor inconsistencies with the potential to cause little to no clinical impact, and major if the overall diagnoses listed by the pathologist and dictated by the surgeon differed significantly and had the potential to alter intraoperative and/or postoperative patient management.
Results: 221 surgical cases with 578 frozen sections were examined. In 23% of the cases the intraoperative diagnosis was not recorded in the operative reports at all. Minor discrepancies were noted in 35% (59) of the remaining cases, and major discrepancies were recorded in 2% of the cases (3). Deferrals accounted for 24% of minor and 33% of major discrepancies overall. 54% of the minor and all major discrepancies were multipart cases. Two of the major discrepancies involved margin assessments, and one represented misinterpretation of the pathology diagnoses on some specimens of a multipart case. One of the major discrepancies led to a major negative impact on patient management where a margin was diagnosed and recorded as positive but interpreted as negative by the surgeon.
Conclusion: Our findings indicate that some verbally reported intraoperative diagnoses are miscommunicated and/or misinterpreted. In rare cases, this can lead to inappropriate intraoperative management. The study highlights the importance of auditing the intraoperative communication in local settings. Potential improvements may be achieved by educational sessions in multidisciplinary setting to address the communication gaps and developing professional guidelines for giving and receiving critical diagnostic information in intraoperative settings.
Description
Keywords
frozen section, communication, pathology