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Non-GYNCriticalValues

Critical Values (CV) for Non-Gynecologic? Cytology Reporting

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Regulatory Requirements
Agency Link
CLIA 88-Section 493.1109  
JCAHO Standard LO3.2:1   
JCAHO 2005-2007 National Patient Safety Goals   
CAP  
This topic was the subject of a CAP Companion Society Meeting at USCAP 2009 presented by Dr. Jan F. Silverman, based on some prior material previously published in Diagnostic Cytopathology in 2006, Critical Values in Cytologydx.doi.org/10.1002/dc.20443.  

Definition of Critical Value: "...is a laboratory test result that represents a pathophysiologic state at such variance with normal as to be life-threatening if an action is not taken quickly and for which an effective action is possible. ..."
Source: MedGenMed. 2007; 9(1): 20. Published online 2007 January 29

Definition of Vital Value: "...is a laboratory result just as important as a critical value, but one for which timing is not as crucial. While a blood glucose under 40 mg/dL is a critical value, positive Pap smears, mammograms, or TB cultures are examples of vital values. ..."  
Source: MedGenMed. 2007; 9(1): 20. Published online 2007 January 29

It appears that for Non-Gynecologic? Cytology reporting, the terminology commonly in use in the published pathology literature is that of "critical value" and not "vital value", although, as Dr. Lundberg delineates in the above reference, this term may actually be more preferable and practical, based on the definition. 

The items in red indicate the consensus opinion regarding the most common CVs for cytology. The items in black, represent other CVs considered important for notification. The CVs were also grade as to need for phone calls: no phone call, notify within 24hr and phone call notification ASAP.

  1. Unexpected malignancy
  2. Disagreement between prelim and final FNA result
  3. Organisms in non-GYN and FNA
  4. Amended report
  5. Very unusual tumor
  6. Disagreement with outside slide review
  7. Anticipated delay in diagnosis (ie. outside consultation)

References:
 

Raouf E.  Nakhleh, Rhona  Souers, Richard W.  Brown. (2009) Significant and Unexpected, and Critical Diagnoses in Surgical Pathology: A College of American Pathologists' Survey of 1130 Laboratories. Archives of Pathology & Laboratory Medicine 133:9, 1375-1378
Online publication date: 1-Sep-2009.

Paul N.  Valenstein, Elizabeth A.  Wagar, Ana K.  Stankovic, Molly K.  Walsh, Frank  Schneider. (2008) Notification of Critical Results: A College of American Pathologists Q-Probes? Study of 121 Institutions. Archives of Pathology & Laboratory Medicine 132:12, 1862-1867
Online publication date: 1-Dec-2008.

Anand S.  Dighe, Jay B.  Jones, Sue  Parham, Kent B.  Lewandrowski. (2008) Survey of Critical Value Reporting and Reduction of False-Positive? Critical Value Results. Archives of Pathology & Laboratory Medicine 132:10, 1666-1671
Online publication date: 1-Oct-2008.

Elizabeth A.  Wagar, Richard C.  Friedberg, Rhona  Souers, Ana K.  Stankovic. (2007) Critical Values Comparison: A College of American Pathologists Q-Probes? Survey of 163 Clinical Laboratories. Archives of Pathology & Laboratory Medicine 131:12, 1769-1775
Online publication date: 1-Dec-2007.

Timothy Craig  Allen. (2007) Critical Values in Anatomic Pathology?. Archives of Pathology & Laboratory Medicine 131:5, 684-687
 
Elizabeth A.  Wagar, Ana K.  Stankovic, David S.  Wilkinson, Molly  Walsh, Rhona J.  Souers. (2007) Assessment Monitoring of Laboratory Critical Values: A College of American Pathologists Q-Tracks? Study of 180 Institutions. Archives of Pathology & Laboratory Medicine 131:1, 44-49
 
Joan H.  Howanitz, Peter J.  Howanitz. (2006) Evaluation of Total Serum Calcium Critical Values. Archives of Pathology & Laboratory Medicine 130:6, 828-830
 
Peter J.  Howanitz,. (2005) Errors in Laboratory Medicine: Practical Lessons to Improve Patient Safety. Archives of Pathology & Laboratory Medicine 129:10, 1252-1261


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Page last modified on Wednesday 10 of March, 2010 22:43:37 MST by admin.
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