Figure 2, B shows the results for various infectious organisms. The “other subset of malignant diagnoses” free-text responses included malignancy in superior vena cava syndrome and malignancy causing paralysis. A small subset classified all new diagnoses of malignancy as urgent/critical. A substantial majority of institutions classified unexpected diagnosis of malignancy as either an urgent diagnosis or a critical diagnosis. Figure 2, A shows the results for malignancies. Three of 26 (12%) respondents indicated that critical values were at the discretion of the individual pathologist, with no specific critical values defined in the policy and 2 of 12 (17%) said the same about urgent values. None of the respondents indicated that there were no results that should be considered critical or urgent. Due to a coding error in the survey question for “significant, unexpected values,” those results could not be interpreted and are not reported. The next question related to the types of diagnoses that are considered critical, urgent, or significant unexpected values. In 2018, the ADASP undertook a survey of its membership to evaluate member's institutional policies in the wake of the 20 consensus statements. It noted the paucity of quality research in this area, yet there has been little subsequent research. That publication laid out 6 broadly written recommendations outlining key planks of a policy for these diagnoses, but left a great deal of discretion to individual institutions. 4 The consensus statement offered definitions for the terms “urgent diagnosis” and “significant, unexpected diagnosis,” recommending those terms as more meaningful than “critical diagnosis” or “critical value” for anatomic pathology. 2 Since 2005, the College of American Pathologists (CAP) Laboratory Accreditation Program has included a checklist item requiring laboratories accredited by CAP to have a policy regarding timely communication of “significant or unexpected surgical pathology findings.” In 2006, the Association of Directors of Anatomic and Surgical Pathology (ADASP) endorsed “the concept of critical diagnoses in anatomic pathology,” 3 and in 2012, ADASP and CAP collaborated on the Consensus Statement on Effective Communication of Urgent Diagnoses and Significant, Unexpected Diagnoses in Surgical Pathology. 1, 2 It was noted that in most cases anatomic pathology “critical values,” unlike clinical pathology critical values, are information critical rather than time critical, although in certain instances there may be a time dimension to the importance of communication of these results. More than a decade ago, questions began to be raised in the literature about the existence of critical values in anatomic pathology. Eighteen of 38 (47%) laboratories report an auditing mechanism for communication.Ĭommunication of critical values to providers has long been an established practice in clinical pathology. Most laboratories document date, time, and person to whom the result was communicated in the final report or an addendum report. The most common time frame was same day many laboratories did not specify a timeframe. A direct phone call to the responsible provider was uniformly considered an acceptable means of communication all other methods had mixed or low support. There was substantial variation in the diagnoses that were considered critical. Twelve of 38 (32%) institutions divided critical values into 2 categories, of which 9 used the College of American Pathologists/Association of Directors of Anatomic and Surgical Pathology terminology 24 used only a single term, of which 11 used critical value. Twenty-five of 38 (66%) respondents had read the College of American Pathologists/Association of Directors of Anatomic and Surgical Pathology consensus statement. Thirty-five of 38 (92%) had a policy on anatomic pathology critical values. Responses were received from 38 institutions.
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