How the critical result reporting system works

At Mount Auburn Hospital in Cambridge, MA, critical lab test results are defined as test results with abnormal or "critical" values, resulting in a potentially life threatening situation for the patient, explains Gregory Gauvin, MD, chair of pathology at Mount Auburn.

For example, a white blood cell count lower than 1,000 or greater than 20,000 is deemed critical. A low white blood cell count typically means the body can't fight off a simple infection as easily, and the patient's condition could become serious very quickly. Chemotherapy could put cancer patients at risk for infection if their white blood cell counts are too low.

Gauvin says a list of various tests and values was derived years ago and is continually updated based on the latest medical information gathered from a number of internal and external sources, including recommendations from the College of American Pathologists. He adds that most of the time, test results with critical values may not be expected, especially in the outpatient setting, which is why it is vital to have a streamlined critical test results communication system.

Gauvin says when an inpatient test comes back with critical values, the physician (usually a resident) is paged immediately. According to statistics from the Mount Auburn Hospital pathology department, 99% of all critical values were called in within 60 minutes in 2005. "If physicians don't answer within 10 to 15 minutes, we'll call back," he says. "We can't sit on these results and say we'll get to them three hours from now. It has to be as soon as possible because it's potentially life-threatening."

The "read-back" policy, in which physicians always should be able to read back exactly what the pathologist or technologist has just communicated to them, also is an important part of the process, Gauvin says. "That's just another way of checking to make sure the physician has heard the message and understands it," Gauvin says. The lab monitors the "read-back compliance" monthly as part of the lab's quality assurance program, and it currently averages 95%.


For more information on the critical result reporting system, contact:

  • Gregory Gauvin, MD, Chair of Pathology, Mount Auburn Hospital, 330 Mount Auburn St., Cambridge, MA 02138. Telephone: (617) 492-3500.