Laboratory of Pathology - Staff

Laboratory of Pathology Consultations Policy

The Laboratory of Pathology is not a Reference Laboratory.

Intra-departmental Consultation

Intradepartmental consultations are encouraged in difficult cases and when an expert opinion is needed. Upon review of cases, the staff on service may decide to seek an additional opinion. The consultation will be sought by the resident or the attending on the case. If the consulted pathologist requests further information or special tests are deemed necessary, these should be obtained. If further information or special tests are not necessary, a consultation should ideally be completed within 24 hours (exception-case submitted for review by multiple consultants).  A case should be resubmitted for consultation following receipt of additional material, further clinical information or completion of special studies. The pathologist in charge of the surgical pathology case must decide whether the results of intra-departmental provide relevant information for inclusion in the patient’s report. If the views of the consulted pathologist are to be reflected in the final report, the interpretation should be included in the note and/or flagged in SoftPath, Results section, under Intradepartmental consultation.  The consulted pathologist may initial the report and may receive a copy of the final report, if requested.

Extra-departmental Consultation

The accompanying letter to an outside consultant should provide the reason for the consultation, specific questions to be answered, and the referring NIH pathologist’s working diagnosis or differential. The outside consultant should be provided with all available information on the case: clinical history; representative H&E sections of all pathologic findings; the original immunoperoxidase slides or unstained slides and/or blocks; electron microscopy prints (if EM was performed), and flow cytometric data (if flow was performed); results of molecular testing. Upon receipt of formal consultation report, the external consultation should be incorporated in the NIH report (if the case was not signed out yet) which will then be included in the patient’s medical record. Copies are provided to all NIH staff pathologists who may have reviewed the case.  Documentation should include:  the letter sent to the outside consultation and the written response from the consultant. Documentation of extra-departmental consultations must be readily accessible within the pathology department. A copy of the consultation surgical pathology report is maintained with the official NIH surgical pathology report (either in the final report, or in a supplemental report). Additionally, a copy of the consultation report is kept separately, and is readily linked to the patient.

Extra-departmental cases submitted to the NIH Pathology Laboratory

These are entered as submitted cases and they are accessioned according to standard practices of the laboratory, and a report issued. Copies of the NIH generated report are sent to any referring physicians within the NIH (patient’s treating physicians) and to originating Laboratory.

Informal Inter or Extra-institutional Consultation:

Informal inter or extra-institutional consultation for other than personal interest, research or educational purposes is strongly discouraged.  When consultation is for diagnostic purposes, a formal reading is absolutely necessary. Under no circumstances, an informal “consultation” by an NIH pathologist can be reflected in any outside surgical pathology report, or used to decide patient’s treatment. 

Consultations provided to clinicians prior to accessing (Curb Side Consultation).

When a diagnosis is sought before accessioning (i.e. curb side consult), the pathologist may verbally inform a clinician of a preliminary diagnosis with the sole purpose for supporting potential patient protocol enrollment. A formal written NIH surgical pathology report is needed to initiate patient treatment.