Critical Diagnoses in Surgical Pathology A Retrospective Single-institution Study to Monitor Guidelines for Communication of Urgent Results

Recent attention has shifted toward defining critical values in surgical pathology, as used in clinical pathology for urgent laboratory results, which require immediate physician notification. The Association of Directors of Anatomic and Surgical Pathology recently proposed a schema for critical values in surgical pathology, better defined as critical diagnoses (CDs). To this end, our department established guidelines defining the timely communication and documentation of urgent findings. To monitor policy effectiveness and to refine a customized list of CDs, we analyzed reports over two identical 6-month periods in 2006 and 2007 for the proper documentation and communication of urgent results. Of all the general surgical pathology cases examined, slightly more than 3% were communicated urgently to the requesting physicians. Approximately 20% of those cases fell into one of the recently proposed CD categories, whereas the remaining cases had conditions that were not specified by the Association of Directors of Anatomic and Surgical Pathology, but nonetheless justified immediate notification based on local practice, such as graft-versus-host disease, acute tubulo-interstitial nephritis, and unsuspected amyloidosis. Consecutive cases from a 4-day period reviewed in 2006 showed that 23.5% notified cases were not properly documented in the final report. However, the compliance rate improved to 100% for a similar period in 2007. Our study demonstrates the need for any CD list to be customized at a given institution to address all the potential diagnoses necessary for patient care and management. It further shows that continuous monitoring and education with regard to CDs and timely communication and documentation of unexpected surgical pathology findings are important measures for optimizing patient safety.