A multistep approach to improving biopsy site identification in dermatology

Physician, staff, and patient roles based on a Delphi consensus

Murad Alam*, Andy Lee, Omar A. Ibrahimi, Natalie Kim, Jeremy Bordeaux, Karen Chen, Scott Dinehart, David J. Goldberg, C. William Hanke, George J. Hruza, Kishwer S. Nehal, Suzanne M. Olbricht, Jeffrey Orringer, Thomas E. Rohrer, Noah S. Scheinfeld, Chrysalyne D. Schmults, John M. Strasswimmer, James S. Taylor, Simon S Yoo, Michael Nodzenski & 2 others Emily Poon Samuelson, Todd Cartee

*Corresponding author for this work

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

IMPORTANCE: Excisional skin cancer surgery is a common procedure, with no formal consensus for mitigating the risk of wrong-site cutaneous surgery. OBJECTIVE: To systematically consider the usefulness and feasibility of proposed methods for correct biopsy site identification in dermatology. EVIDENCE REVIEW: Survey study with a formal consensus process. Item development was via a literature review and expert interviews, followed by 2 stages of a Delphi process to develop consensus recommendations. FINDINGS: In total, 2323 articles were reviewed in the literature search, with data extraction from 14. Twenty-five experts underwent 30-minute structured interviews, which were transcribed and coded. The resulting survey was composed of 42 proposed interventions by multiple stakeholders (biopsying physicians, operating physicians, nurses, ancillary staff, patients, caregivers, and family members) at 3 time points (day of biopsy, delay and consultation period, and day of definitive surgery). Two rounds of a Delphi process with 59 experts (25 academic and 34 private practice) scored the survey. Strong consensus was obtained on 14 behaviors, and moderate consensus was obtained on 21 other behaviors. In addition, a 2-state simultaneous algorithm was developed to model surgeon behavior on the day of definitive surgery based on surgeon and patient perceptions. CONCLUSIONS AND RELEVANCE: When definitive surgery is performed after the initial biopsy and by a different surgeon, procedures can be implemented at several time points to increase the likelihood of correct site identification. The specific circumstances of a case suggest which methods may be most appropriate and feasible, and some may be implemented. The risk of wrong-site cutaneous surgery can be reduced but not eliminated.

Original languageEnglish (US)
Pages (from-to)550-558
Number of pages9
JournalJAMA Dermatology
Volume150
Issue number5
DOIs
StatePublished - Jan 1 2014

Fingerprint

Dermatology
Dermatologic Surgical Procedures
Consensus
Physicians
Biopsy
Medical Errors
Ambulatory Surgical Procedures
Interviews
Private Practice
Skin Neoplasms
Caregivers
Referral and Consultation
Nurses
Surveys and Questionnaires
Surgeons

ASJC Scopus subject areas

  • Dermatology

Cite this

Alam, Murad ; Lee, Andy ; Ibrahimi, Omar A. ; Kim, Natalie ; Bordeaux, Jeremy ; Chen, Karen ; Dinehart, Scott ; Goldberg, David J. ; Hanke, C. William ; Hruza, George J. ; Nehal, Kishwer S. ; Olbricht, Suzanne M. ; Orringer, Jeffrey ; Rohrer, Thomas E. ; Scheinfeld, Noah S. ; Schmults, Chrysalyne D. ; Strasswimmer, John M. ; Taylor, James S. ; Yoo, Simon S ; Nodzenski, Michael ; Samuelson, Emily Poon ; Cartee, Todd. / A multistep approach to improving biopsy site identification in dermatology : Physician, staff, and patient roles based on a Delphi consensus. In: JAMA Dermatology. 2014 ; Vol. 150, No. 5. pp. 550-558.
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title = "A multistep approach to improving biopsy site identification in dermatology: Physician, staff, and patient roles based on a Delphi consensus",
abstract = "IMPORTANCE: Excisional skin cancer surgery is a common procedure, with no formal consensus for mitigating the risk of wrong-site cutaneous surgery. OBJECTIVE: To systematically consider the usefulness and feasibility of proposed methods for correct biopsy site identification in dermatology. EVIDENCE REVIEW: Survey study with a formal consensus process. Item development was via a literature review and expert interviews, followed by 2 stages of a Delphi process to develop consensus recommendations. FINDINGS: In total, 2323 articles were reviewed in the literature search, with data extraction from 14. Twenty-five experts underwent 30-minute structured interviews, which were transcribed and coded. The resulting survey was composed of 42 proposed interventions by multiple stakeholders (biopsying physicians, operating physicians, nurses, ancillary staff, patients, caregivers, and family members) at 3 time points (day of biopsy, delay and consultation period, and day of definitive surgery). Two rounds of a Delphi process with 59 experts (25 academic and 34 private practice) scored the survey. Strong consensus was obtained on 14 behaviors, and moderate consensus was obtained on 21 other behaviors. In addition, a 2-state simultaneous algorithm was developed to model surgeon behavior on the day of definitive surgery based on surgeon and patient perceptions. CONCLUSIONS AND RELEVANCE: When definitive surgery is performed after the initial biopsy and by a different surgeon, procedures can be implemented at several time points to increase the likelihood of correct site identification. The specific circumstances of a case suggest which methods may be most appropriate and feasible, and some may be implemented. The risk of wrong-site cutaneous surgery can be reduced but not eliminated.",
author = "Murad Alam and Andy Lee and Ibrahimi, {Omar A.} and Natalie Kim and Jeremy Bordeaux and Karen Chen and Scott Dinehart and Goldberg, {David J.} and Hanke, {C. William} and Hruza, {George J.} and Nehal, {Kishwer S.} and Olbricht, {Suzanne M.} and Jeffrey Orringer and Rohrer, {Thomas E.} and Scheinfeld, {Noah S.} and Schmults, {Chrysalyne D.} and Strasswimmer, {John M.} and Taylor, {James S.} and Yoo, {Simon S} and Michael Nodzenski and Samuelson, {Emily Poon} and Todd Cartee",
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Alam, M, Lee, A, Ibrahimi, OA, Kim, N, Bordeaux, J, Chen, K, Dinehart, S, Goldberg, DJ, Hanke, CW, Hruza, GJ, Nehal, KS, Olbricht, SM, Orringer, J, Rohrer, TE, Scheinfeld, NS, Schmults, CD, Strasswimmer, JM, Taylor, JS, Yoo, SS, Nodzenski, M, Samuelson, EP & Cartee, T 2014, 'A multistep approach to improving biopsy site identification in dermatology: Physician, staff, and patient roles based on a Delphi consensus', JAMA Dermatology, vol. 150, no. 5, pp. 550-558. https://doi.org/10.1001/jamadermatol.2013.9804

A multistep approach to improving biopsy site identification in dermatology : Physician, staff, and patient roles based on a Delphi consensus. / Alam, Murad; Lee, Andy; Ibrahimi, Omar A.; Kim, Natalie; Bordeaux, Jeremy; Chen, Karen; Dinehart, Scott; Goldberg, David J.; Hanke, C. William; Hruza, George J.; Nehal, Kishwer S.; Olbricht, Suzanne M.; Orringer, Jeffrey; Rohrer, Thomas E.; Scheinfeld, Noah S.; Schmults, Chrysalyne D.; Strasswimmer, John M.; Taylor, James S.; Yoo, Simon S; Nodzenski, Michael; Samuelson, Emily Poon; Cartee, Todd.

In: JAMA Dermatology, Vol. 150, No. 5, 01.01.2014, p. 550-558.

Research output: Contribution to journalArticle

TY - JOUR

T1 - A multistep approach to improving biopsy site identification in dermatology

T2 - Physician, staff, and patient roles based on a Delphi consensus

AU - Alam, Murad

AU - Lee, Andy

AU - Ibrahimi, Omar A.

AU - Kim, Natalie

AU - Bordeaux, Jeremy

AU - Chen, Karen

AU - Dinehart, Scott

AU - Goldberg, David J.

AU - Hanke, C. William

AU - Hruza, George J.

AU - Nehal, Kishwer S.

AU - Olbricht, Suzanne M.

AU - Orringer, Jeffrey

AU - Rohrer, Thomas E.

AU - Scheinfeld, Noah S.

AU - Schmults, Chrysalyne D.

AU - Strasswimmer, John M.

AU - Taylor, James S.

AU - Yoo, Simon S

AU - Nodzenski, Michael

AU - Samuelson, Emily Poon

AU - Cartee, Todd

PY - 2014/1/1

Y1 - 2014/1/1

N2 - IMPORTANCE: Excisional skin cancer surgery is a common procedure, with no formal consensus for mitigating the risk of wrong-site cutaneous surgery. OBJECTIVE: To systematically consider the usefulness and feasibility of proposed methods for correct biopsy site identification in dermatology. EVIDENCE REVIEW: Survey study with a formal consensus process. Item development was via a literature review and expert interviews, followed by 2 stages of a Delphi process to develop consensus recommendations. FINDINGS: In total, 2323 articles were reviewed in the literature search, with data extraction from 14. Twenty-five experts underwent 30-minute structured interviews, which were transcribed and coded. The resulting survey was composed of 42 proposed interventions by multiple stakeholders (biopsying physicians, operating physicians, nurses, ancillary staff, patients, caregivers, and family members) at 3 time points (day of biopsy, delay and consultation period, and day of definitive surgery). Two rounds of a Delphi process with 59 experts (25 academic and 34 private practice) scored the survey. Strong consensus was obtained on 14 behaviors, and moderate consensus was obtained on 21 other behaviors. In addition, a 2-state simultaneous algorithm was developed to model surgeon behavior on the day of definitive surgery based on surgeon and patient perceptions. CONCLUSIONS AND RELEVANCE: When definitive surgery is performed after the initial biopsy and by a different surgeon, procedures can be implemented at several time points to increase the likelihood of correct site identification. The specific circumstances of a case suggest which methods may be most appropriate and feasible, and some may be implemented. The risk of wrong-site cutaneous surgery can be reduced but not eliminated.

AB - IMPORTANCE: Excisional skin cancer surgery is a common procedure, with no formal consensus for mitigating the risk of wrong-site cutaneous surgery. OBJECTIVE: To systematically consider the usefulness and feasibility of proposed methods for correct biopsy site identification in dermatology. EVIDENCE REVIEW: Survey study with a formal consensus process. Item development was via a literature review and expert interviews, followed by 2 stages of a Delphi process to develop consensus recommendations. FINDINGS: In total, 2323 articles were reviewed in the literature search, with data extraction from 14. Twenty-five experts underwent 30-minute structured interviews, which were transcribed and coded. The resulting survey was composed of 42 proposed interventions by multiple stakeholders (biopsying physicians, operating physicians, nurses, ancillary staff, patients, caregivers, and family members) at 3 time points (day of biopsy, delay and consultation period, and day of definitive surgery). Two rounds of a Delphi process with 59 experts (25 academic and 34 private practice) scored the survey. Strong consensus was obtained on 14 behaviors, and moderate consensus was obtained on 21 other behaviors. In addition, a 2-state simultaneous algorithm was developed to model surgeon behavior on the day of definitive surgery based on surgeon and patient perceptions. CONCLUSIONS AND RELEVANCE: When definitive surgery is performed after the initial biopsy and by a different surgeon, procedures can be implemented at several time points to increase the likelihood of correct site identification. The specific circumstances of a case suggest which methods may be most appropriate and feasible, and some may be implemented. The risk of wrong-site cutaneous surgery can be reduced but not eliminated.

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