Critical Communication

Abstract

At one time or another most medical technologists and pathologists have been frustrated trying to notify primary caregivers about critical laboratory results. In some instances, responsibility for a patient has been transferred to a new physician, and multiple calls are required to identify a caregiver who will accept the result. In other instances, no responsible caregiver can be reached despite repeated efforts. Laboratory staff require a median of 7 min to notify a primary caregiver about a critical result for an inpatient (1 ) and twice as much time for outpatients (2 ). Given that about 1% of laboratory results qualify as critical (3 ), the cumulative staff time consumed in calling critical results may be substantial.In this issue, Parl et al. (4 ) describe their experience with an electronic system for broadcasting critical laboratory results to the pagers of caregivers. In their institution, 6851 critical results were automatically paged over the course of 9 months. Eighty percent of pages were acknowledged by a physician, with the percentage of acknowledged transmissions increasing progressively over the course of the study to 89% in the final month. Unacknowledged pages were transferred to telephone operators, who reached a physician 70% of the time and a nurse the remaining 30%. The authors' experience parallels experiences in other laboratories that have installed commercially available or laboratory-developed automated notification systems. Does this intervention "close the loop" on criticalresult reporting? Not yet. Automated notification systems help address an immediate and important problem that frustrates laboratory professionals-efficiently contacting a responsible caregiver and documenting that communication has taken place (5 ). Yet, the emergence of these systems should not cause us to lose sight of several other equally important challenges involving critical results and their communication.

Meeting Regulatory Requirements by the Use of Cell Phone Text Message Notification With Autoescalation and Loop Closure for Reporting of Critical Laboratory Results

“…Evidence suggests that this is only the end of the beginning of an intervention to correct a grossly abnormal pathophysiologic finding to avert an adverse outcome. 19,24 Key challenges in critical laboratory result notification, succinctly summarized here, 24 include defining critical results, improving communication with end users, appropriate routing of results to an alternative receiver, and compliance with standards without losing sight of the objectives. Already, increasing emphasis is made to ensure timely institution of interventions when a critical result arises.…”