To Sign Out or Not to Sign Out? Part 1

That is the question. Every year. Around the holidays or three-day weekends.

Normally biopsies or surgical specimens collected the day before are reviewed the next day. In a majority of cases, the case can be “signed out” meaning your opinion goes into a surgical pathology report and becomes part of the medical record. New malignancies, in general, require notification of the ordering provider to inform them the biopsy is malignant.

Most days of the year, Monday through Friday you sign out cases from the day or two before, if they require additional tissue, sections, special stains or immunohistochemical stains.

Then it might be the Wednesday before Thanksgiving or the Friday before a three-day Christmas or New Years weekend as we had this year. Most pathologists I think sign out the case, call the provider, move those slides from one pile to be “read” to the “completed” pile.

But it makes me wonder, does the clinician call the patient Friday afternoon on the eve before Christmas Eve or Christmas Eve or before Thanksgiving or, I don’t know, before Memorial Day.

Pathologists require themselves to sign out “80% of cases within 2 days” or “90% of cases within 3 days”. If you complete the case, but don’t sign it out, the clock is still running and can affect the turn-around time as a “quality metric”.

I wrote a post earlier this year entitled “Christmas Eve FNA” about a young woman I performed an FNA on with metastatic breast cancer on Christmas Eve.

It makes me think, that as a patient, if you don’t want to know, you wouldn’t get your biopsy before Thanksgiving, Christmas, New Years, Birthday, Anniversary or other important date if you didn’t want to know the answer. Some will say they get the biopsy on Friday so they have the weekend to “recuperate”. Clinicians may tell them the will have “results from the lab” in about a week when in reality it may be a day or two.

So, on this past Friday afternoon, just as I did the night before Thanksgiving, I signed out new malignancies and called the clinicians. I didn’t ask but some mentioned they would call the patients “next week”, perhaps they themselves on their way to airports or family gatherings for the holiday.

So, if we had waited until Monday or Tuesday morning to sign out these cases would it affected any patient care or follow up or anything beyond a turn around time metric?

Do doctors call back benign results perhaps on a Friday, particularly before a holiday, but wait until the following week for malignant calls?

More on this in Part 2 to follow.