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Definitions and Scope
As noted on the first page, reporting of critical test results presents concerns because of the potential for serious harm to patients when timely follow-up action is not taken. A group of Massachusetts hospitals (MA Coalition) and the Massachusetts Hospital Association (MHA), during 2002-2003, collaborated in a patient safety initiative aimed at improving their ability to communicate critical test results in a timely and reliable way to the clinician who can take action. The multi-disciplinary participants concluded that solutions would have to address improving communication, teamwork, and information transfer, all basic system factors related to patient safety.
Critical Test Results - The MA Coalition defined this term broadly, as “all values/interpretations for which delays can result in serious adverse outcomes for patients.” [iv]
Generally, CTRs will be defined by the facility, which may utilize values (often stated as a high-low range) developed by professional organizations such as the College of American Pathologists (CAP). Another definition, from a pathologist, states: “Critical values represent a pathophysiologic state at such variance with normal as to be life-threatening unless something is done promptly and for which some corrective action could be taken. The critical value list should be deliberately limited to a crucial small variety of tests with undeniable critical limits so as not to dilute the effectiveness of, and respect for, this notification.” [v]
“Panic” Values: This term sometimes appears on lists of critical test values and appears to be used interchangeably with the term “Critical.” Sometimes, the term “Panic” is used in combination with the word “Critical” (as in Critical/Panic values). However, “Critical” appears to be the current preferred term.
The Coalition’s Consensus Group, (made up of multi-disciplinary stakeholders from the MA Coalition facilities), developed a “starter set” of test values that are sufficiently abnormal as to be considered critical. However, the group indicated that these values and interpretations were not intended to be a standard for all facilities. Rather, hospitals should establish their own thresholds of critical results, consistent with the populations they serve.
Scope of tests: CTRs encompass findings from pathology and various laboratories, cardiology, radiology, and other diagnostic tests, such as imaging studies, arterial blood gas tests, and electrocardiograms. Reporting problems can occur in various treatment locations, including inpatient, emergency and ambulatory care.
Setting Time Frames: The MA Coalition, in its Safe Practice Recommendations for Communicating Test Results, has recommended that facilities establish explicit time frames for reporting CTRs directly to the ordering provider. [vi] JCAHO, in its 2005 Patient Safety Goals, under the communication goal, requires that facilities measure and assess the timeliness of their critical test reporting, and timeliness of receipt by the responsible clinician. However, it does not mandate “acceptable” time frames. [vii]This is left to professional groups, such as CAP, American College of Surgeons, and the American College of Radiology, which have established acceptable time frames. For example, CAP-accredited labs must have procedures for immediate notification of the responsible clinician when test results are within the critical value range.
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In the next installment, we will look at the following: (1) Factors that have been identified as contributing to problems in the CTR notification process and (2) JCAHO’s new Patient Safety Goals, especially those that aim to improve communication among caregivers, as a means of improving patient safety. |