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Critical values in pediatric surgical pathology: definition, implementation, and reporting in a children's hospital
Cheryl M Coffin1, Krista Spilker, Amy Lowichik
1Department of Pathology, Primary Children's Medical Center and University of Utah, Salt Lake City, UT 84113, USA.
Insights
Pediatric surgical pathology now has established critical values for timely communication of unexpected findings. This policy improved verbal reporting and documentation, enhancing patient care through multidisciplinary collaboration.
Area of Science:
- Pathology
- Pediatric Medicine
- Healthcare Communication
Background:
- Timely communication of significant surgical pathology findings is crucial for patient care.
- Existing critical value literature lacks systematic assessment in pediatric surgical pathology.
- A need exists for standardized protocols for reporting unexpected findings in pediatric surgical pathology.
Purpose of the Study:
- To develop and implement pediatric surgical pathology critical values for verbal reporting.
- To establish a policy and process for reporting and documenting critical findings.
- To assess the effectiveness of the implemented policy through quality review.
Main Methods:
- Surveyed pediatric pathologists and subspecialists to define critical values.
- Implemented a policy for verbal reporting and documentation of critical findings.
- Conducted retrospective and prospective quality reviews of critical value cases.
Main Results:
- Critical values represented 9.4% of surgical pathology accessions.
- Policy implementation significantly improved verbal reporting and documentation rates (97.3%) compared to pre-policy (80%).
- Multidisciplinary input was vital for identifying clinically relevant critical values.
Conclusions:
- A standardized policy for pediatric surgical pathology critical values enhances timely communication and documentation.
- Multidisciplinary collaboration is essential for defining and reporting critical findings.
- An alternative term to 'critical values' may be beneficial for unexpected findings requiring prompt communication.
Abstract:
Timely communication of significant or unexpected findings in surgical pathology can significantly improve patient care. Although surgical pathology critical values have been published, no systematic assessment in pediatric surgical pathology has been published. We surveyed pediatric pathologists and pediatric subspecialists to develop pediatric surgical pathology critical values for verbal reporting before the final pathology report. A policy and process for reporting and documentation was implemented, with retrospective and prospective quality review. Critical values cases constituted 9.4% of surgical pathology accessions. Retrospective analysis revealed that 80% (73/91) had been reported and documented before policy implementation. Following implementation, 97.3% (402/413) were verbally reported and documented. A multidisciplinary group provided valuable information about critical values that might not have been obvious to pediatric pathologists but are important for patient care. Although the term critical values has become embedded in the surgical pathology literature, we would propose an alternative term for significant or unexpected findings that require timely communication and documentation.
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