Synopsis
Critical values are fundamental aspects of the surgical pathology laboratory. High-quality results and pathology services are dependent upon it. In contemporary surgical pathology, the importance of critical values is often undervalued. Many laboratories lack a developed critical values system, which is a significant oversight. Implementing a robust critical values plan can greatly enhance operational efficiency. A comprehensive critical values system includes case classification and protocols for situations ranging from life-threatening emergencies to non-urgent cases. This article will delve into the concept of critical values, highlighting their essential role in modern surgical pathology and in delivering high-quality pathology services.
Critical Value Reporting
Immediate notification is a must in surgical pathology. In surgical pathology, critical values are essential to ensure timely and effective communication. They require a phone call and discussion with the clinician promptly. Critical values in surgical pathology need prompt and appropriate intervention to avert potentially harmful outcomes. Working with critical values involves laboratory personnel, clinical providers, informaticists, and hospital management. The communication needs to be done ideally within 30 minutes. This involves all cases in chemistry, toxicology, hematology, therapeutic drugs, microbiology, anatomical pathology, and cytopathology.
Critical Value Communication
The advisable means of critical value communication are internal phone calls. If there is an issue with phone calls, a secure messaging system can help as well. In surgical pathology, the essential concept of value is not evident and there is no established protocol for determining, reporting, and documenting these results. The concept of critical value was first determined in 1972.
What Are Critical Values at the Core?
It refers to a laboratory finding outside the normal range that might constitute an immediate health risk otherwise hard to detect. The critical value is also known as critical diagnosis, urgent diagnosis, and treatable, immediately life-threatening diagnosis. Regardless of the attributed terms, an immediate report to a healthcare provider is necessary to take the required actions.
Critical Diagnoses
In surgical pathology, turnaround time goes from 2 to 14 days and involves tissue processing, slide preparation, typing, and signing of reports. In these reports, some critical results demand rapid reporting for rapid intervention before routine reporting. Surgical pathologists need to determine all the important points to differentiate between life-threatening conditions and those that can be solved with routine procedures. In addition to critical diagnoses, there are a few diagnoses that are unusual or unexpected and should be addressed during treatment, although not immediately as critical ones. The results are usually named as significant or unexpected diagnoses.
Critical Values Research
If you study the available literature, the number of studies evaluating the necessity of determining and reporting critical and unexpected pathology results is quite limited. Critical value in surgical pathology: evaluating the current status in a multicenter study quotes a report by M. Mireskadari that determines which findings should be considered critical in surgical pathology. Nearly 90 different conditions were extracted. Critical Values in Surgical Pathology by Telma C. Pereira et al. report identified 13 critical cases and 4 out of these 13 documented phone calls to clinicians. The study surveyed 2,659 surgical pathology reports regarding critical values in surgical pathology.
Effective Communication in Critical Values Research
Surgical pathologists need to reach an agreement with clinician colleagues on what kinds of diagnoses should be regarded as critical. Effective communication and proper documentation in pathology reports are the key components of establishing a critical diagnosis policy. Delay or failure to adhere to the documentation could be devastating. Written reports also shouldn’t be overlooked.
Power of Verbal Communication
Verbal communication can hasten the reporting process. However, it’s also a proven fact that communication can bring misunderstandings. Thus, all reports need to be documented. Additionally, semi-automated reporting via special codes can help you. Generic critical diagnosis guidelines should be used as a template because the list needs to be customized in each laboratory.
Information in Critical Diagnoses
Surgical pathology recognizes the critical value when dealing with numerical data. Moreover, surgical pathology is information-sensitive, and surgical pathologists are involved in the interpretation of findings rather than numerical data. It is noteworthy to say that pathologists and non-pathologists can have different expectations of critical value, and these expectations can bring misalignment and influence the patient treatment plan. Worth noting, that multiple laboratories working in surgical pathology do not have proper estimation and documentation plans.
Critical Communication
One of the most critical functions of pathology reports or laboratory services is to facilitate clear, accurate, and rapid communication of critical test results with care providers. Critical diagnoses refer to practices that might have an immediate impact on patient care. Significant and unexpected diagnoses should be expected. In such cases, one must rely on the pathologist’s experience and judgment for identification. Therefore, when an urgent decision needs to be made based on pathological findings, the clinician should not wait for the information to reach in a routinely documented report.
Critical Reporting Systems
The laboratory Medical Director develops the list of critical values. The Director establishes critical report procedures that involve lab technicians, clinical personnel, clinical informaticists, and hospital management. These systems categorize the urgency level of critical values and expected turnaround time. Some key practices involve using red for life-threatening values that require prompt action and immediate call, orange to emphasize significantly abnormal results that require quick action but are not immediate, and yellow for abnormal results, but not life-threatening. The escalation policy also needs to be created, and the order of receivers needs to be defined. It is also necessary to revise the critical value list periodically and assess its effectiveness regularly.
Conclusion
Critical values are a crucial element in high-quality surgical pathology service. Every laboratory wanting to improve its services needs to have a well-developed critical values system. Some critical values require immediate reaction, and for some, the action can be performed within days. Although many surgical pathology laboratories have these systems limited, those who have developed it, usually, divide the possible actions into three levels, red which means life-threatening situations, orange which requires quick, but not immediate action, and yellow which is not life-threatening. Every laboratory needs to create an escalation policy and define the order of receivers. Regular revision and assessing the critical value list are also of utmost importance.
