Critical Test and Critical Result Reporting
June 9, 2006
Patient safety and quality of care can be compromised when there are delays in completion of critical tests or in communicating the results of critical tests or critical test results to the licensed individual legally and by hospital policy allowed to take action on the results of the diagnostic test.
Joint Commission on Accreditation of Healthcare Organizations (JCAHO) 2006 National Patient Safety Goal (NPSG) 2c requires hospital organizations to measure, assess, and if appropriate, take action to improve the timeliness of reporting, and the timeliness of receipt by the licensed caregiver, of critical test results and values.
NPSG (2c) is actually addressing two situations, not one. This becomes apparent upon careful reading of the frequently asked questions (FAQs) and the implementation guidelines for the goal. Although not as clearly delineated in the goal as in these other documents, critical tests (i.e., tests ordered "Stat") and critical results (i.e., "Panic" or Hi/Low values) are not the same thing. It is the responsibility of the licensed practitioner receiving the result of a critical test or a critical result to evaluate its significance in light of the patient's clinical situation. Identification of a fail-safe, alternate process in the event of delays in reaching the licensed practitioner responsible for directing the patient's care is a necessary part of the design of an organization's process.
In order to ensure timely completion of critical tests and receipt of critical results, the principles of performance improvement (PI) must be implemented. For all critical tests, the acceptable time from order to result being available must be identified by each organization, cognizant of the time it actually takes to complete various diagnostic tests, i.e., imaging studies verses laboratory testing. For critical results, the acceptable time from result being available until it is received by the licensed practitioner empowered to take action on the result, must be identified. Once these times have been identified, data regarding any delay in timely completion of a critical test and communication of the critical result or delay in timely receipt of a critical result must be collected, aggregated and relayed to leadership for analysis and action.
Critical Test Measurement Parameter:
Elapsed time from the time the test was ordered to the time the result (whether normal or abnormal) is reported to a responsible licensed care giver (that is, the turnaround time of the critical test).
Critical Result Measurement Parameter:
Elapsed time from when the critical (abnormally high or low) result was determined to be critical to the result is first known to the time it is reported to the licensed responsible caregiver (that is, the result known-to-reporting interval).
Suggested Policy for Critical Tests
All diagnostic tests ordered "STAT" or "Now" will be considered to be critical tests. These include tests performed in the laboratory, in imaging, and in cardiology, if the ordering practitioner is not the person performing the diagnostic test. The ordering practitioner is expected to indicate the date and time the order is written. Staff authorized to receive a verbal or telephone order for a critical test must also include the date and time the order is received. Staff processing (transcribing) the critical test order will communicate to the department/service/area performing the test the critical nature of the test to expedite its timely completion. The results of all critical tests will be immediately communicated to the ordering practitioner whether abnormal or not. Should the time from ordering the critical test to the availability of its result exceed ________ for laboratory tests or _________for non-laboratory tests, the administrative supervisor will be notified immediately. A decision will then be made as to an alternate practitioner to receive the result of the critical test. Alternate recipients of the critical test result might include another member of the ordering practitioner's group practice, the physician member of the rapid response team, the ED physician, the hospitalist, and medical staff leaders.
Suggested Policy for Critical Results
All diagnostic tests resulted as a critical/panic value/red level will be communicated to the ordering practitioner within _____, including those tests ordered for completion in a routine fashion, such as next day. Should the time from the critical test result being available until its communication to the ordering practitioner exceed _______, the _____ will be notified immediately. Likewise, this individual will also be notified for any delay of more than _____ in communicating the critical test result to the ordering practitioner. The same process will be followed as in the situation above when an alternate recipient of a critical test result must be identified.
Laboratory staff will call the nurse providing care to the patient to telephonically relay all critical test results and all critical results performed in the laboratory. The nurse will document and read back the result of the test, as per policy _______. The nurse will also document the date and time of receipt, the person calling the result, and include their own name and title.
Critical tests and critical results for those tests performed outside the laboratory (imaging and cardiac testing) require direct practitioner-to-practitioner communication. The practitioner receiving the result of a critical test or a critical result is expected to repeat back the information they have received. To ensure patient safety, the nurse providing care to the patient will also be notified. This notification need not follow the same path as the communication to the licensed practitioner.
All critical tests completed beyond the accepted time and all delays in communicating critical results to the licensed practitioner will be reported to _____. A monthly report will be generated and forwarded to the PI office. These data will be presented for analysis at the quarterly _______ meeting. Data regarding any delay in contacting the licensed practitioner will also be forwarded to the medical staff leadership for analysis and action.
Speaking on behalf of my colleagues at The Greeley Company any of us would be happy to assist you in fine-tuning your response to this National Patient Safety Goal including helping craft policy and processes workable to your organization.
I also want to highlight for any of you who have experienced an unannounced survey recently that we at The Greeley Company are expert at assisting you in "clarifying" findings prior to submitting your Evidence of Standards Compliance (ESC) so that you are only responding to well-founded findings. Hospitals that have engaged us for this purpose have been surprised (pleasantly!) to see 20-70% of their initial findings reversed upon our helping the hospital write "clarifying evidence" that the process in question was indeed compliant with the standard at the time of survey or that the surveyor had made an error in applying the standard. No sense preparing an ESC when you are already in compliance! We call this service our "Rapid Response Team." For more information please call me directly at 262-242-3631 or call our Practice Manager, Sandi Reen at 888-749-3054.
Practice Director of Accreditation
and Regulatory Compliance
The Greeley Company
JCAHO Survey Preparation
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If you would like to discuss your organization's specific needs, please call Sandi Reen, Practice Manager, at 888/749-3054, ext. 3263, e-mail firstname.lastname@example.org, or visit us on the Web at www.greeley.com.
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