How Promptly Are Inpatients Treated for Critical Laboratory Results?

Kuperman, Gilad J.; Boyle, Debbie; Jha, Ashish K.; Rittenberg, Eve; Ma’Luf, Nell; Tanasijevic, Milenko J.; Teich, Jonathan M.; Winkelman, James W.; Bates, David W.

doi:10.1136/jamia.1998.0050112

Cited by 78 publications

(53 citation statements)

References 8 publications

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“…11 In a report describing 13 days in the life of a busy medical unit in an urban hospital, 1938 of 201,037 laboratory results (0.96%) met the hospital's critical reporting criteria. 12 These findings suggest that someone or some process had to sort through about 104 noncritical test results before discovering 1 critical finding. This activity is reminiscent of a never-ending game of ''Where's Waldo,'' and this is where the attending physician and nurse practitioner come in.…”

mentioning

confidence: 96%

Managing Laboratory Results in the Nursing Home Setting: Looking for Waldo or Seeking Wisdom

Lawhorne¹

2009

Journal of the American Medical Directors Association

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mentioning

confidence: 96%

Managing Laboratory Results in the Nursing Home Setting: Looking for Waldo or Seeking Wisdom

Lawhorne¹

2009

Journal of the American Medical Directors Association

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“…Attention should also be directed toward exploiting the latent potential of electronic notification systems to provide just-in-time authoritative information about how to correct a critical abnormality, such as hyperkalemia or hypercalcemia. After a physician is first notified about a critical result, initiating treatment requires almost 2 h-much longer than the time needed for laboratory staff to contact the physician (7 ). Perhaps this interval can be shorted if clinical laboratory professionals come to see their role as providers of critical advice as well as critical results.…”

Section: Optimizing Communication For the End Usermentioning

confidence: 99%

Critical Communication

Valenstein

2010

Clinical Chemistry

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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.

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“…Although this system has improved timely intervention, inability to reach care providers undermines its impact (1 ). Prior analysis of critical result reporting practices has identified qualitative factors that lead to delays in critical result reporting, such as patient location, missing provider information, patient heterogeneity, and nonideal "panic" values (2 ).…”

Section: To the Editormentioning

confidence: 99%