Five Ways to Reduce Errors in Pathology Synoptic Reporting

Synoptic reporting is a clinical documentation method that’s popular among pathologists because of its ease of use and ability to increase efficiency [1].

Synoptic reporting is a clinical documentation method that’s popular among pathologists because of its ease of use and ability to increase efficiency [1].

While the reporting system helps eliminate inaccuracies, inconsistencies and delays common in narrative reporting methods, errors in synoptic pathology reports still occur. By making a few key template adjustments, you can significantly reduce the likelihood of error.

Best Practices for Modifying Pathology Synoptic Reporting Templates to Reduce Errors

• Start with the CAP Cancer Checklist templates. The College of American Pathologists provides a peer reviewed library of synoptic templates for pathology reporting. Be sure you are taking advantage of this excellent platform as your starting point.  Ideally you will be using synoptic reporting software that comes pre-loaded with this template library and that will accept updates from CAP with minimal effort on your part.
• Make items “exclusive” on the pathology reporting template. When you are completing a synoptic report you sometimes have the option of selecting one or more checkboxes to answer a section. Human error enters in when you accidentally select an option such as “Not applicable” or “Not identified,” and then go on to check-off additional boxes in the same list.  To eliminate that kind of error, change options that don’t make sense with additional selections in the list to “exclusive” if your software supports that feature.  This action disables the user from selecting additional checkboxes in the same list or from answering non-applicable questions in the report.

Note that additional fields are non-selectable (gray).

• Link reference notes to questions. When filling out a synoptic report you may encounter a reference at the end of a question, such as “(Note A).” Unless you’re familiar with what that reference is, you will have to take the time to look it up – and that hurts your productivity. If you need to see that note to fully understand the measure being reported on, failing to look it up may result in an error. Solve this issue by linking the note directly to the question on the template.  Leading pathology reporting packages allow a help or similar icon to be associated with a reference note. When clicked, you will see text describing the note rather than having to go to another application or manual reference. 
• Eliminate irrelevant template content with smart branching.  When you see all the questions on a CAP template, you understand that some of them will not be relevant to the case at hand.  Seeing those irrelevant questions, however, ads the necessity to single out the questions you do need to answer and eliminate those you do not; and that in turn increases the likelihood of making an error. Reduce confusion by adjusting the template’s layout with smart branching so that dependent questions only appear in response to selection of a response that make them relevant.  This ensures obvious errors – where answer A cannot co-exist with answer B – can no longer occur. 

Click to enlarge. 

• Leave the simple checks to the software.  A lot of the errors that can occur in completing pathology reporting can be checked with simple rules configured in your reporting software. This frees you up to focus your review and QA on more subtle errors that demand clinical expertise.  For example, if you select the tumor site of “Other” but fail to specify the location, the software should present a message in real time and prevent you from submitting the incomplete report.  While this is what we have come to expect in software we use away from work, our expectations for healthcare software are often lower.  This can mean that online error checking capabilities that do exist in our reporting software are not being used.

Synoptic reporting can be a very effective tool for pathologists that improves the quality of care relative to narrative methods, while increasing efficiency.  Achieving these benefits, however, is not achieved by switching to the synoptic format alone.  Reducing errors and improving efficiency requires flexibility in the reporting software chosen and commitment by pathologists and their organizations to invest in template configuration.