Summary of New Consensus Statement:
- Each institution should create its own policy regarding Urgent Diagnoses and Significant, Unexpected Diagnoses in Anatomic Pathology. This policy should be separate from critical result or panic value policies in clinical pathology with the expectation of a different time frame for communication.
- Pathology departments should determine specific urgent diagnoses in collaboration with the clinical staff. These diagnoses should include situations in which urgently conveying the information may directly affect patient care. An example of an urgent diagnosis is an unknown life-threatening infection in an immune-compromised patient. Pathologists, however, should use their experience and judgment to communicate any diagnoses, even if not included in the policy. In hospital practice, approval by the appropriate institutional governing body is recommended.
- Determination of a significant, unexpected diagnosis is heavily dependent on the pathologist's judgment as a physician. By their nature, significant, unexpected diagnoses cannot always be anticipated. Examples such as a frozen section–permanent section discordance that affects patient care or a clinically unsuspected malignancy may be listed in the policy.
- Pathologists should communicate urgent diagnoses as soon as possible because it may directly affect patient care, but each institution should establish a reasonable time frame. The consensus statement authors recommend no longer than the same day on which the diagnosis is made. Communication of significant, unexpected diagnoses should occur as soon as practical; pathologists may exercise their judgment as to the appropriate timing of communication.
- Pathologists should communicate verbally and directly with physicians, but other satisfactory methods of communication may be established and validated by each institution. Backup communication plans should be developed for those circumstances in which a physician is not available.
- Pathologists should document the communication. This can be done in the original pathology report, as an addendum, in the electronic medical record, or by another mechanism. Documentation should include the person with whom the case was discussed, the time and date, and when appropriate, the means of communication.