Pathology and patient safety: the critical role of pathology reduction and informatics in error quality initiatives

Pathology is entering a new era where it will need to mobilize new resources to face the challenges posed by the Institute of Medicine's (IOM) and Rand Corporation's call to arms for patient safety [1,2]. In 1999 the IOM reported in To Err is Human: Building a Safer Health System [1] that the medical community was responsible for many serious errors in the delivery of care. The focus of the report was on system errors, and it was very weak in its dealings with diagnostic errors. However, the report, in a very pointed way, implicated the lack of clear-cut clinical documentation and the lack of standards (both in vocabularies and in common data elements) as key factors in many errors. The report has had a broad impact on health care delivery and patient safety research. A review of the implications of the IOM report for pathology by Sirota [3] in 2000 lays the foundation for the central thesis of this article. It is the authors' goal to describe how pathology informatics can play a critical role in the detection, prevention, and correction of errors. Just as the IOM report has been a call to arms, so a report by the Rand Corporation [2] in 2002 on the delivery of care in over 20 urban centers has caused great concern to the public and health care providers. This report estimated that nearly half of the patients treated for a variety of diseases had actually met the approved standards of care. Of particular importance in this report was the frequent citation of laboratory testing as a central issue in improper care delivery. Unsurprisingly, it was not improper test ordering that was at the top of the error list for diagnostic interpretation, but lack of adequate testing as the primary laboratory concern. These are two landmark articles that every pathologist should read and digest thoroughly, because they have great implications for our future practice. Given the relative novelty of patient safety and health care research in pathology, this article serves to provide an overview of important developments in pathology and informatics as they relate to patient safety and error reduction initiatives. The authors strongly believe that patient safety in pathology is inextricably linked to cost-effective and waste-free or lean management practice methodologies. Lean management principles, Six Sigma, and quality improvement are crucial to achieving our goal of error-free delivery of care in pathology.