INTERDEPARTMENTAL CONSULTATIONS.
DRAFT COPY ONLY.
(Procedure 137).
http://www.netautopsy.org/axsop/axsop137.htm


NEXT PAGE
PREVIOUS PAGE
RETURN TO TABLE OF CONTENTS

United States Government Work, uncopyrighted, public-domain, DRAFT COPY ONLY. This document does not necessarily represent the views or policies of any United States Government agency. This document is provided "as is", without warranty of any kind, express or implied, including but not limited to the warranties of merchantability, fitness for a particular purpose and non-infringement. In no event shall the authors be liable for any claim, damages or other liability, whether in an action of contract, tort or otherwise, arising from, out of, or in connection with the document or the use or other dealings made with the document. .



PRINCIPLE OF THE TEST.

      For new diagnoses of cancer (excluding basal cell carcinoma of skin), or other diagnoses at the discretion of the attending pathologist, an interdepartmental consultation is made and documented in the COMMENT section of the final pathology report.



SPECIMEN REQUIRED.
      All human tissue excised at surgery, outpatient clinics, and postmortems, fresh or in fixative, along with a filled-out Tissue Examination Form (U. S. Standard Form 515, USSF515).



STEP-BY-STEP DESCRIPTION.

      1. FOR NEW DIAGNOSES OF CANCER (excluding basal cell carcinoma of skin), or other urgent diagnoses at the discretion of the attending pathologist, an INTERDEPARTMENTAL CONSULTATION IS MADE AND DOCUMENTED in the COMMENT section of the final pathology report.

      2. The interdepartmental consultation may take the form of a FACE-TO-FACE DISCUSSION with the responsible clinician; a TELEPHONE DISCUSSION with the clinician; a CONFIRM/PRIORITY EMAIL sent to the clinician; or a report of the case at an interdepartmental meeting. In case of a telephone communication, the COMMENT must indicate that the diagnosis has been discussed with or read to the clinician, and that the diagnostic information has been READ BACK by the clinician.

      3. If the submitted paperwork for a particular case contains the legible name of the responsible clinician, legible contact information (beeper or telephone number), and the responsible clinician responds after two attempts at reaching him/her, then this communication is documented in a COMMENT in the pathology report, and SNOMED-coded as described below. If the clinician is unreachable by this mechanism, then a CONFIRM/PRIORITY EMAIL is sent to the clinician on the secure VistA® MAILMAN system. Even if the clinician's name is illegible, a responsible person's name can usually be determined from CPRS NOTES.

      4. In the event that the responsible clinician is unreachable by all these mechanisms, then a confirm/priority email is forwarded to the Chief, Medicine Service, or Chief, Surgery Service, or other appropriate authority.

      5. Each month, a list of unfollowed-up attempts to reach a responsible clinician are reported to the INVASIVE PROCEDURES REVIEW COMMITTEE, as described in Procedure 138.

      6. One of the following SNOMED Procedure-codes is attached to the electronic surgical pathology report, for administrative summary purposes, as documentation that the consultation has taken place. 
 P-0650   .......... CONSULTATION, NOS
 P-0655   .......... CONSULTATION, COMPLEX
 P-0658   .......... CONSULTATION, BY EMAIL
 P-0659   .......... CONSULTATION, BY TELEPHONE
 P-030112 .......... AFIP CONSULTATION
 P-030122 .......... INVASIVE PROCEDURES REVIEW COMMITTEE
 P-030123 .......... DERMATOPATHOLOGY CONSULTATION
 P-030125 .......... CLINICOPATHOLOGIC CONFERENCE


      7. A two-year study was performed, in which the frequency of encoded, documented consultations per month was tabulated, for calendar years 2002-2003, as shown below. In general, the consultation rate is 10-25%. 
           MONTH                  PATIENTS                 SPECIMENS

                                                                
   January, 2002 ......... 70/412 (16.99%) ......... 71/442 (16.06%)
  February, 2002 ......... 64/388 (16.49%) ......... 68/416 (16.35%)
     March, 2002 ......... 58/369 (15.72%) ......... 59/410 (14.39%)
     April, 2002 ......... 84/436 (19.27%) ......... 89/484 (18.39%)
       May, 2002 ......... 57/390 (14.62%) ......... 61/433 (14.09%)
      June, 2002 ......... 37/359 (10.31%) ......... 37/394 ( 9.39%)
      July, 2002 ......... 47/439 (10.71%) ......... 49/484 (10.12%)
    August, 2002 ......... 41/426 ( 9.62%) ......... 42/461 ( 9.11%)
 September, 2002 ......... 40/405 ( 9.88%) ......... 40/453 ( 8.83%)
   October, 2002 ......... 43/419 (10.26%) ......... 43/462 ( 9.31%)
  November, 2002 ......... 46/328 (14.02%) ......... 51/355 (14.37%)
  December, 2002 ......... 61/285 (21.40%) ......... 62/311 (19.94%)

                                                                
   January, 2003 .........123/371 (33.15%) .........134/435 (30.80%)
  February, 2003 ......... 94/342 (27.49%) ......... 95/406 (23.40%)
     March, 2003 .........124/406 (30.54%) .........131/484 (27.07%)
     April, 2003 .........140/467 (29.98%) .........145/535 (27.10%)
       May, 2003 .........122/416 (29.33%) .........126/476 (26.47%)
      June, 2003 .........119/408 (29.17%) .........122/479 (25.47%)
      July, 2003 ......... 73/445 (16.40%) ......... 77/517 (14.89%)
    August, 2003 ......... 69/354 (19.49%) ......... 74/419 (17.66%)
 September, 2003 ......... 80/426 (18.78%) ......... 84/504 (16.67%)
   October, 2003 ......... 99/403 (24.57%) .........106/461 (22.99%)
  November, 2003 ......... 74/358 (20.67%) ......... 77/406 (18.97%)