Histopathology departments already audit diagnostic errors

BMJ 1996; 313 doi: https://doi.org/10.1136/bmj.313.7049.117 (Published 13 July 1996) Cite this as: BMJ 1996;313:117
  1. A D Ramsay
  1. Consultant pathologist Histopathology Department, Southampton University Hospitals NHS Trust, Southampton SO16 6YD

    EDITOR,—John Warden, in his report on diagnostic errors made by locum consultant histopathologist Dr Samuel Kiberu, repeatedly asserts that there are no comparative data on mistakes in pathological diagnoses and states that the report on this case calls for new research.1 The research that has already taken place, both in Britain and in the United States, seems to have been overlooked. In 1986 a review of 12 934 cases in the British Army Histopathology Registry detected 521 diagnoses (4.0%) that contained an error; 141 of these errors (1.1%)were classed as “clinically significant” and were likely to have affected the patient's care.2 In an audit of 518 cases in Southampton in 1993, errors were found in 20 cases (3.8%), and in six (1.2%) theerror was judged to be clinically significant.3 Two pathology departments in the United States have reported the effects of appointing an extra senior pathologist to check all their diagnoses. In one department the checker detected 14 discrepancies of potential clinical significance in 5397 cases (0.26%),4 while in the other department major errors were detected in 1.2% of 2694 cases.5 Although these studies used slightly different methods, it is notable that three identifieda rate of important errors of between 1.1% and 1.4%.

    Many histopathology departments in Britain now operate internal audit systems to detect diagnostic errors. The Southampton system has been running since 1988, and our error rates to the end of 1995 remain comparable with the published results.3 The emerging consensus is that in routine diagnostic pathology some form of error will occur in roughly 3-4% of cases and an error that is likely to affect the patient's management will occur in 1.0-1.5%. In this light, Dr Kiberu's error rates of 14% and 9%1 certainly seem to be high.


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