George Bernard Shaw once said, “The single biggest problem in communication is the illusion that it has taken place.” This is especially true in the healthcare sector. Unfortunately, ineffective diagnostic communication can have dire consequences for patients. It is estimated that there are 40,000–80,000 deaths in the United States each year due to diagnostic error. Poor communication of laboratory test results is a contributing factor in these errors.

Critical laboratory results, also known as panic results or values, are defined as test results that exceed established high or low limits. Abnormal results are not the same as critical values. “Abnormal” and “critical” are not used interchangeably.

Critical results are considered life threatening and require corrective action to be taken promptly. After the result has been verified and entered into the lab’s computer system, notifications are sent to the patient’s physician and/or physician’s representative, the ordering entity, and any other clinical personnel responsible for the patient’s care.

Critical Results Reporting Standards

According to the “National Patient Safety Goals” set by The Joint Commission, timely reporting of critical results need to be made to the responsible licensed caregiver(s) within an established time frame so that the patient can be promptly treated.

They outline three Elements of Performance to achieve this goal:

1. Collaborate with organization leaders to develop written procedures for managing the critical results of tests and diagnostic procedures that address the following:

• The definition of critical results of tests and diagnostic procedures.
• By whom and to whom critical results of tests and diagnostic procedures are reported.
• The acceptable length of time between the availability and reporting of critical results of tests and diagnostic procedures.

2.  Implement the procedures for managing the critical results of tests and diagnostic procedures.

3.  Evaluate the timeliness of reporting the critical results of tests and diagnostic procedures.

Critical Lab Communication

When a critical lab value is verified, oftentimes a phone call is made to report the result and it is documented in the Laboratory Information System. To comply with patient safety goals, the person taking the call must read back (read-back) the patient’s name, the hospital number and all laboratory results. Read-back is required to ensure accurate transmission of information.

Historically, verbal communication has been considered the preferred procedure for notifying critical values. However, the need to quickly and accurately communicate lab diagnostics is paramount for lowering the risk of a patient experiencing an adverse medical event.

An article appearing in the National Library of Medicine titled, “Critical laboratory values communication: summary recommendations from available guidelines” finds that, “The results of surveys conducted in the UK, Italy, US, China, and Croatia have notably emphasized that there is poor consensus regarding many aspects of critical values management. This is a rather concerning issue, for not less than three good reasons. First, the lack or delayed communication of critical values has been clearly recognized as a source of significant harm to the patients, since these test results may lead to treatment modification in as many as 98% of patients admitted to surgical wards and up to 91% of those admitted to medical departments. Then, critical values communication is an integral part of many accreditation procedures for medical laboratories, including the universally agreed International Organization for Standardization (ISO). Finally, timely notification of critical values has been endorsed as one of the leading quality indicators of the post-analytical phase [of laboratory medicine] by the Working Group “Laboratory Errors and Patient Safety” (WG-LEPS) of the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC).”

Information technology tools are becoming an essential component of medical lab communication because they provide:

• Fast and accurate communications
• Automated systems
• Reporting
• Simplified communications
• HIPAA compliance to protect patient health information

Read part 2 of 2 next week.