|Year : 2017 | Volume
| Issue : 9 | Page : 12-15
Adequacy of clinical information supplied by clinicians for histopathologic diagnosis: The university of Benin teaching hospital experince
Gerald Dafe Forae, Darlington Ewaen Obaseki
Department of Pathology, University of Benin Teaching Hospital, Benin city, Nigeria
|Date of Web Publication||2-Aug-2017|
Gerald Dafe Forae
Department of Pathology, University of Benin Teaching Hospital, P.M.B. 1111, Benin City
Source of Support: None, Conflict of Interest: None
Background: The volume of workload in histopathology laboratories need to be accurately measured so that resources can be used appropriately in a challenging clinical environment. Aims: The main objective of this work is to assess the adequacy of clinical information provided by clinicians requesting for histopathological investigations. Materials and Methods: A total of 1659 sequential histopathological request forms sent to Department of Histopathology of the University of Benin Teaching Hospital between January 1, and December 31, 2005, were retrospectively studied and analyzed. The provision of data by surgeons and physicians were compared in a Microsoft Excel 2000 Spreadsheet using the Chi-square test with Yates's correction where appropriate. Given the number of variables being assessed, a Bonferonni correction was applied, and a value of P = 0.001 was therefore considered the limit of significance. Results: A total of 1659 pathology request cards were audited in this study. Of these, 1382 cases accounting for 83.3% were a request made by surgeons while 277 constituting 16.7% were a request sent by physicians. Hence, the ratio of a request made by surgeons and physicians were 5:1. Among the request made by surgeons, the most common request was from the Surgery Department accounting for 783 (47.2%) of all requests. Among the 277 requests made by physicians, the department of internal medicine had the highest volume accounting for 122 (7.35%) of all cases. A total of 1415 out of 1659 were found to be inadequately completed accounting for 85.3%. There were significant differences in the information on ethnicity, date, time and clinical summary recorded by surgeons and physicians and the P < 0.001, respectively. Conclusion: Majority of the pathology request cards sent by clinicians are inadequately completed with an extremely high preanalytic phase errors.
Keywords: Adequacy, clinical information, diagnosis, histopathology
|How to cite this article:|
Forae GD, Obaseki DE. Adequacy of clinical information supplied by clinicians for histopathologic diagnosis: The university of Benin teaching hospital experince. N Niger J Clin Res 2017;6:12-5
|How to cite this URL:|
Forae GD, Obaseki DE. Adequacy of clinical information supplied by clinicians for histopathologic diagnosis: The university of Benin teaching hospital experince. N Niger J Clin Res [serial online] 2017 [cited 2020 Jan 23];6:12-5. Available from: http://www.mdcan-uath.org/text.asp?2017/6/9/12/212004
| Introduction|| |
The main goal of Histopathology Department is to render a correct and complete diagnosis to the correct patient in a timely fashion in a way that is understandable and useful to the clinicians treating the patients. Most histopathologists do however believe that clinicians make attainment of this goal doubly difficult for them by the inadequacy of clinical information supplied. There is a perception among histopathologists that clinicians do not understand the operations of Histopathology Departments, based partly on the poor quality of requests received for histopathological investigations.,
The workload of histopathological laboratories needs to be accurately measured so that resources can be used appropriately in a challenging clinical environment as it has long been recognized that the elimination of outdated, redundant, and unnecessary laboratory work can greatly improve standards.
Currently, there is society driven need to reduce errors in medicine, including histopathology which because of its complex nature is inherently error prone. Multiple issues contribute to this, among which is the variable input and inconsistency of requests sent to the histopathology laboratory.
We decided to audit and investigate the adequacy of information supplied by clinicians requesting a histopathological investigation in a bid to make a recommendation on the ways to correct these abnormalities.
| Materials and Methods|| |
Totally, 1659 sequential histopathological request forms sent to Department of Histopathology of the University of Benin Teaching Hospital between January 1, and December 31, 2005, were retrospectively studied and analyzed. Requests for cytological examination were excluded from this study. Each request was assessed for the presence and completeness of information prompted by the request forms including demographic details (address, full name, date of birth or age, ethnic group, sex, hospital number, and patient location); nature of specimen; the type of investigation required; an adequate clinical history (defined as a clinical history and/or differential diagnosis); the signature, name, and contact number of the requesting clinician as well as time and date of collection of the specimen. These data should be present on 100% of requests if completed correctly. The provision of data by clinicians from the four main clinical Departments of Surgery, Internal Medicine, Paediatrics, and Obstetrics was compared in a Microsoft Excel 2000 Spreadsheet using the Chi-square test with Yates's correction where appropriate. Given the number of variables being assessed, a Bonferonni correction was applied, and a value of P = 0.001 was therefore considered the limit of significance.
| Results|| |
A total of 1659 pathology request cards were audited during this 1 year retrospective study. Of these, 1382 cases accounting for 83.3% were request card sent by surgeons while 277 constituting 16.7% were a request sent by physicians. Hence, the ratio of request made by surgeons and physicians was 5:1. Among the request made by surgeons, the most common request was from the Surgery Department accounting for 783 (47.2%) requests. This was followed by requests made by the Department of Obstetricians and Gynaecology Department constituting 391 (23.1%) request cards. A large amount of requests were also sent as outside referral cases accounting for 200 (12.06%). A few number of requests also came from the dental clinic constituting only 8 (0.5%) of all the request cards. Among the 277 requests made by physicians, the Department of Internal Medicine had the highest request accounting for 122 (7.35%) of all cases. Again outside referrals and request made by family physicians constituted 57 (3.44%) and 52 (3.13%), respectively. Paediatrics Department recorded 32 (1.93%) while request by Clinical Pathology Departments accounted for 14 (0.84%) as shown in [Table 1].
[Table 2] shows common omissions and errors committed by clinicians while completing the pathology request cards. A total of 1415 out of 1659 were found to be inadequately completed hence lack one or more clinical information. Of the 1659 available cards, at least 66.2% or more were lacking in some aspect of the patients' bio-data (such as full names, age, sex, ethnicity, and address). In the bio-data section, there was a significant difference in the ethnicity request filled by the surgeons 454 (32.9%) and physicians 106 (38.3%) with a Chi-square of 26.67 and a P < 0.001. The exact time specification (i.e. am/pm) had the poorest records as only 244 (14.7%) out of 1659 had this recorded on the pathology request cards. There was a significant difference in the date recorded by surgeons 986 (54.2%) and physicians 192 (69.3%) as the Chi-square and the P value were 52.50 and <0.001, respectively. Only 1090 (65.7%) had relevant information on patients' clinical summary, and there was a significant difference in the between surgeons 926 (67%) and physicians 164 (59.2%) as the Chi-square and P value were 19.08 and <0.001, respectively.
|Table 2: Computation of parameters ommitted by clinicians while completing pathology request cards|
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| Discussion|| |
Since the approach to any specimen received in the surgical pathology laboratory depends on the specific clinical problem to be resolved by the interpretation of that specimen, it is essential that each specimen should as much as possible be accompanied by an adequate description of what it represents, as well as an appropriate clinical history. The surgical pathologist should design the request form so that the clinician filling out the form is sure to appreciate the need for supplying this information.
Name of the patient and other demographic information is paramount in identifying the patient. Again it helps in correlating the card with the specimen and previous investigation results. This is corroborated by the previous report by Burton and Stephenson. Adequacy of clinical history permits a multifaceted dimension of tailoring the report to suit the clinicians and to also discard inappropriate investigation to be ordered for. This is similar to reports of other researchers., Once more this is relevant to the pathologist in requesting for relevant special staining techniques. It is also very relevant in reducing the turn-around-time (TAT) and enhances all postanalytic procedures for accurate issuance of histology report. Studies have shown that failure to provide adequate history may prolong the TAT for histological diagnosis to be made by the pathologist.,,
Overall, in this study request received by surgeons and physicians are not adequately completed with clinical details. In this study, among all patients name was the most commonly supplied information. This constituted 100% of the cases. This is similar to reports of other researchers. Surgeons and physicians expect the best results of histopathology services from pathologist. However, studies have shown that clinicians do not give adequate clinical information in return to this expectation. This could lead to hindrance in the services generated. Information on the nature of specimen is paramount as it helps to prevent errors due to the identification of the specimen.
Most clinicians assumed that pathologist has all it takes to make a definitive diagnosis on a tiny piece of tissue obtained from patients sent for histology even if adequate clinical history is not produced., The clinical history forms the bulk of communication between the clinician and the pathologist. Studies have shown that barrier in communication between clinicians and pathologist can make histological diagnosis difficult. For histological diagnosis to be real and accurate, the clinicians should be able to provide all the necessary clinical information related to the patient illness.
Studies have shown that most cases of malpractice claims leveled against practicing pathologist results primarily from inadequate clinical information by clinicians.,,, Studies done by McBroom and Ramsay noted that approximately 1 in every 10 cases that was reviewed during peer group pathological conferences results from inadequate clinical history. Again Troxel and Sabella noted that 20% of all misdiagnosis may results from inadequate clinical history.
In this study, an average of 85.3% of the request cards were not properly filled. This important finding although slightly lower is similar to findings documented in Australia, where about 94% of request cards were not properly filled. Comparing this study to other series of similar studies from developed countries, there is a significant difference in the ways preanalytical data are entered in the pathology request cards. Most developed countries use the information communication and technology devices involving the intranet and the computerized requesting system to enter their preanalytic data. This cannot be said for data entry in developing countries including Nigeria where most clinical data are entered manually. Preanalytical data completed manually may lead to either lack of clinical information or incorrect clinical information., Again another reason is based on the fact that most developing countries do not adhere strictly on the emphasis laid on quality management in filling of preanalytic pathology request forms. In Caucasian series, there is complete adherence to this protocol. This has helped in in complete data generation in developed countries. Series of Caucasian studies as shown in the European standardization body, Australian health insurance commission and the United States policy on clinical laboratory improvement act are useful tool for adequacy and completion of preanalytical pathology requisition forms.,
However, in spite of the fact that most developing countries operate a manually filling procedure of pathology preanalytical requisition forms, studies have it that most cases of inadequate clinical information are mainly due to lack of willingness and lackadaisical attitudes. Reason being that most clinician do not attach importance to detailed requested on the pathology request card.
| Conclusion|| |
The majority of the pathology request cards sent by clinicians are inadequately completed with an extremely high preanalytic phase errors. We recommend strict implementation of rejection criteria, constant monitoring, and constant health education as modalities for effectively improving the adequacy of laboratory request forms.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Burton JL, Stephenson TJ. Are clinicians failing to supply adequate information when requesting a histopathological investigation? J Clin Pathol 2001;54:806-8.
Burton JL, Goepel JR, Lee JA. Great expectations: Demand management of sputum cytology leads to 86% reduction. J Pathol 2000;190:54A.
Shorrock K. Use of histopathology services by general practitioners: Recent changes in referral practice. J Clin Pathol 1993;46:989-92.
Nakhleh RE, Gephardt G, Zarbo RJ. Necessity of clinical information in surgical pathology. Arch Pathol Lab Med 1999;123:615-9.
McBroom HM, Ramsay AD. The clinicopathological meeting. A means of auditing diagnostic performance. Am J Surg Pathol 1993;17:75-80.
Troxel DB, Sabella JD. Problem areas in pathology practice. Uncovered by a review of malpractice claims. Am J Surg Pathol 1994;18:821-31.
Royal North Shore Hospital Quality Use of Pathology Program Report 2000. Australia Government Department of Health and Ageing. Available from: http://www.health.gov.au
. [Last accessed on 2010 Nov 11].
Zardo L, Secchiero S, Sciacovelli L, Bonvicini P, Plebani M. Reference intervals: Are interlaboratory differences appropriate? Clin Chem Lab Med 1999;37:1131-3.
Burnett L, Chesher D, Mudaliar Y. Improving the quality of information on pathology request forms. Ann Clin Biochem 2004;41(Pt 1):53-6.
Ogbaini-Emovon E, Ojide CK, Mordi RM, Oko-Oboh GA, Osumah O. Inadequate information in laboratory test requisition in a tertiary hospital in Benin-City, Nigeria. Ann Biomed Sci 2013;12:6-13.
Plebani M. The clinical importance of laboratory reasoning. Clin Chim Acta 1999;280:35-45.
Moskowitz MJ, Mark AM. Clinical View of Laboratory Investigation. Medical Laboratory Observer; July, 1984. Available from: http://www.mlo-online
. [Last accessed on 2010 Nov 10].
[Table 1], [Table 2]