1. ADASP Survey on Communication of Urgent and Unexpected Values
Paul N. Staats, MD
Associate Professor of Pathology
University of Maryland School of Medicine

2. Notice of Faculty Disclosure
In accordance with ACCME guidelines, any individual in a position to influence and/or control the content of this ASCP CME activity has disclosed all relevant financial relationships within the past 12 months with commercial interests that provide products and/or services related to the content of this CME activity.
The individual below has responded that he/she has no relevant financial relationship(s) with commercial interest(s) to disclose:
Paul N. Staats, MD

5. What’s new since 2012?
Let’s do a survey!

6. Survey Demographics
- Vast majority of responses from academic medical centers
- Multiple responses from the same address suffix were censored (n=5)

7. Does your laboratory have a policy for communication of urgent and
significant unexpected diagnoses (“Critical values”) in anatomic pathology?

8. Have you read the CAP/ADASP Consensus Statement on Effective
Communication of Urgent and Significant Unexpected Diagnoses in
Surgical Pathology and Cytopathology?

9. Do you use the CAP/ADASP terminology of “Urgent Diagnoses” and
“Significant Unexpected Diagnoses” in your policy?

10. What diagnoses are considered “___ Diagnoses” in your laboratory?17 12

11. What diagnoses are considered “___ Diagnoses” in your laboratory?
*Malignancy in SVC syndrome;
Neoplasms causing paralysis

12. What diagnoses are considered “___ Diagnoses” in your laboratory?
Specific Situations:
AFB
Immunocompromised patient
New/unexpected diagnosis
Specific site:
Heart valves
Across the boards, slightly more organisms considered “urgent” than “Critical”

13. What diagnoses are considered “___ Diagnoses” in your laboratory?
Specific Situations:
Fungus
Immunocompromised patient
New/unexpected diagnosis
Tissue invasion
Specific site:
Sinus, ENT
Lung
Heart valves
CSF/CNS
Specific fungi:
Pneumocystis
Not candida
Across the boards, slightly more organisms considered “urgent” than “Critical”

14. What diagnoses are considered “___ Diagnoses” in your laboratory?
Specific Situations:
CMV
Immunocompromised patient
Unexpected or new diagnosis
Specific site:
Kidney
Liver
Placenta
Lung
Colon
Across the boards, slightly more organisms considered “urgent” than “Critical”

15. What diagnoses are considered “___ Diagnoses” in your laboratory?
Specific Situations:
HSV
Immunocompromised patient
New/unexpected diagnosis
Specific site/situation:
Esophagus
On Pap during pregnancy
Across the boards, slightly more organisms considered “urgent” than “Critical”

16. What diagnoses are considered “___ Diagnoses” in your laboratory?
Specific Situations:
Toxoplasma
Immunocompromised patient
New/unexpected diagnosis
Neonate
Across the boards, slightly more organisms considered “urgent” than “Critical”

17. What diagnoses are considered “___ Diagnoses” in your laboratory?
Specific Situations:
Bacteria
New/unexpected diagnosis
Specific Sites:
Cardiac valves
Unexpected osteomyelitis
CSF
Pathologist judgement
Across the boards, slightly more organisms considered “urgent” than “Critical”

18. What diagnoses are considered “___ Diagnoses” in your laboratory?
Other:
Transplant rejection (3)
Crescentic glomerulonephritis (2)
Absence of villi in POC (3)

19. What are acceptable methods of communicating ____ diagnoses in your laboratory?
Other:
-EMR Message
-In person

20. If you use indirect communication ( , text message, fax), do you have a mechanism for confirming receipt of messages?

21. What is the expected timeframe for communication of ____diagnoses in your laboratory?

22. What is the expected timeframe for communication of ____diagnoses in your laboratory?
Other:
Urgent Significant Unexpected Critical
Prior to signout (1)
Immediately (1)
Within 1day/24 hours (2) Within 1 day/24 hours (3)
ASAP (1) Reasonable ASAP (4)

23. What is the expected timeframe for communication of ____diagnoses in your laboratory?

24. How do you document communication of _____ Diagnoses?

25. What elements are documented?

26. If your institution has clinical trainees, how does your policy define a “responsible physician” who can receive a critical value?

27. If a specimen is procured by a provider who is not part of the patient’s continuing care team (e.g. interventional radiology), does your policy specify who is the preferred physician to receive a critical value?
Note – the responses here sum to 41, not 38 – need to ask Ryan to review data

28. Does your laboratory have a procedure for escalation if the initial contact person is unavailable?
Does your laboratory have a procedure for auditing and quality assessment of reporting of urgent and unexpected diagnoses?

29. Caveats
38 total responses
Predominantly academic
Self-reported

30. Summary
The vast majority of labs have a policy for AP “Critical” values
Minority (~1/3) have distinct policies for “urgent” versus “significant unexpected” diagnoses
Even when they do, little evidence that the two are handled differently
Little consensus on what diagnoses qualify
Major frozen-final discrepancy (~80%)
New, unexpected malignancy (~80%)
Little consensus on method or timing of communication
But uniform agreement that phone call to provider is good
Relative consensus on documentation
In report
Expected elements