Communicating Test Results to Providers and Patients.pdf

COMMUNICATING TEST RESULTS TO PROVIDERS AND PATIENTS

MCP NUMBER 11-27-148

Montana VA Health Care System Fort Harrison, MT 59636

Signatory Authority:

Executive Director

Responsible Owner:

Chief of Staff

Rescinded Document:

11-19-148, Communicating Test Results to Providers and Patients, 10/01/2018

Effective Date:

April 6, 2022

Recertification Date:

April 30, 2027

1. POLICY

It is the policy of Montana VA Health Care System that test results must be communicated to the ordering, or surrogate practitioner, within a timeframe allowing prompt attention and appropriate clinical action to be taken.

a. Critical test results and findings must be communicated within one (1) hour of the finding by direct communication from the diagnostic practitioner/surrogate to the ordering practitioner/surrogate.

b. All test results requiring action (Abnormal) must be communicated by the ordering provider, or designee, to patients no later than 7 calendar days from the date on which the results are available.

c. For test results that require no action (Normal), results must be communicated by the ordering provider, or designee, to patients no later than 14 calendar days from the date on which the results are available.

d. Depending on the clinical context, certain test results may require review and communication in shorter time-frames.

e. In exceptional circumstances, it may be necessary to delay communication of test results beyond the time-frames identified above. For example, communicating a diagnosis of terminal cancer in a sensitive, empathic manner may require a face-to-face visit at a time convenient to the patients, which could extend beyond the 7 day time-frame. Determination of how to report these results are best made on a case-by-case basis. The delay in communication must be documented in the electronic medical record.

f. Review and discussion of test results must be provided to the patient, or patient’s personal representative, with an opportunity for questions and discussion.

April 6, 2022 MCP 11-27-148

2. JUSTIFICATION

To provide a policy regarding communication of patient test results to practitioners and to patients.

3. RESPONSIBILITIES

a. The Director is responsible for:

(1) Ensuring the development and administration of this policy is implemented in regards to the communication of test results to ordering providers and to patients.

(2) Ensuring that the VHA Directive 1088 is followed.

b. Chief of Staff (COS) is responsible for:

(1) Reviewing monitors of test communication results.

(2) Resolving process deficiencies with Service Chiefs, should they occur.

(3) Ensuring the Clinical Service Chiefs establish a chain of responsibility within their department for receipt of test results and communication of results to patients.

(4) Ensuring that the diagnostic Practitioner or designee Identifies, documents, and communicates all abnormal and critical test results to the ordering practitioner or designee.

(5) Ensuring the ordering practitioner takes appropriate clinical action and follow-ups, documents treatment actions, and communicates test results to patients in accordance with this policy.

c. Service Chiefs, Supervisory Laboratory, and Supervisory Radiology or Designee is responsible for:

(1) Ensuring all departmental personnel are familiar with critical exams and critical results policy. Establishing procedures consistent with this policy that identify all providers and staff who can communicate test results to patients. The SOP should also specify what type of test results providers and staff can communicate, and how the results are communicated (e.g., synchronous versus asynchronous.)

(2) Monitoring timeliness of reporting critical results, analyzing aggregated data and formulating action plans necessary to improve timeliness of reporting as appropriate.

(3) Reporting the monitoring of test results and aggregated data to the Patient Safety Committee on a quarterly basis.

d. Diagnostic Provider, Clinical Laboratory Scientists, Pathologists, Radiologists, or designee is responsible for:

(1) Identifying and communicating within one (1) hour all critical test values or results to the ordering practitioner, the practitioner’s surrogate, or the supervisor, as appropriate.

(2) Documenting the time and means of communication of critical results and the name of the practitioner contacted in the medical record.

(3) Ensuring that verified test result reports are available in the patient’s electronic medical record in a timely manner.

e. Ordering Practitioner/Surrogate is responsible for:

(1) Placing the initial order with appropriate information.

(2) Taking responsibility for results of any orders that have been placed that includes appropriate clinical action.

(3) Documents treatment actions in response to critical, emergent, and abnormal test results in the patient’s electronic record.

(4) Communicates test results to patients in accordance with this policy.

(5) Assigning a surrogate to receive critical test result notifications when they are not available to review results in a timely manner.

f. Health Administrative Service is responsible for:

(1) Maintaining updated contact information for all patients in CPRS and all providers and the designees who have access to CPRS.

(2) Making this contact information available to all staff involved in the test result notification processes.

4. PROCEDURES

a. TYPES OF PUBLICATIONS: Policy. VHA Directive 1088 Communicating Test Results

Ordering Process:

(1) The ordering practitioner, entering the initial order, will make sure all pertinent information is provided. Examples of pertinent information include: the type of specimen, date of collection, the name of the ordering practitioner, and/or the reason for the test.

(2) At times of anticipated unavailability, a surrogate will be assigned by the ordering practitioner to receive critical test results/values

(3) Appropriate clinical action and follow-up on abnormal results of any tests ordered will be initiated and completed even if they are not the patient’s PCP.

b. Laboratory and Pathology Medicine Reporting:

(1) Critical results must be reported within 1 hour of the critical result findings by direct communication from the diagnostic practitioner, or surrogate, to the ordering practitioner or surrogate practitioner.

(2) The communication of the critical result findings must be documented in the Computerized Patient Record System (CPRS).

(3) Telephone communications are to be written down and “read back” by the individual receiving the critical result.

(4) See Attachment A for the listing of the critical laboratory tests/values and results for VA Montana.

(5) See Attachment B for the Pathology and Microbiology Critical Values.

(6) Inpatient during Business Hours:

a) The staff member identifying the critical result finding(s) will initiate direct communication to the ordering/attending provider or identified surrogate.

b) A mandatory critical value alert is entered into CPRS.

c) If the ordering provider/surrogate is not immediately contacted a second attempt is made within 15 minutes.

d) Should further contact attempts fail, the Laboratory Service Clinical Contact Master List is consulted to determine the appropriate Service Chief/Alternate provider and that person will be contacted.

1) The Laboratory Service Clinical Contact Master List is maintained as a ready reference for lab staff and is available at all times.

e) If necessary, the Medical Officer of the Day (MOD) is contacted by telephone or pager.

f) See matrix below under (9) d.

(7) Outpatients during Business Hours:

communication to the ordering provider or identified surrogate.

b) A mandatory critical value alert is entered into CPRS.

c) If the ordering provider/surrogate is not immediately contacted a second attempt is made within 15 minutes.

d) If the ordering provider cannot be reached upon second attempt and the ordering provider is not the primary care provider for the patient, the primary care provider will be notified by direct communication of the critical test result.

e) If the ordering provider or the primary care provider cannot be reached, the Service Chief will be notified of the critical test result by direct communication.

f) See matrix below under (9) d.

(8) Inpatient after Business Hours:

communication with the Ordering Provider and a mandatory critical value alert is entered into CPRS.

b) If direct communication with the ordering provider does not occur, a second attempt is made within 15 minutes.

c) If the second attempt does not occur, direct communication with the MOD will occur.

d) Repeat attempts will be made until the appropriate provider is notified. Other staff may be utilized in locating the providers.

e) See matrix below under (9) d.

(9) Outpatient after Business Hours:

communication to the Medical Officer of the Day (MOD) or the Emergency Department (ED) physician and a mandatory critical value alert is entered into CPRS.

b) If direct communication with the MOD or ED physician does not occur, a second attempt is made within 15 minutes.

c) Repeat attempts will be made until the appropriate provider is notified. Other staff may be utilized in locating the providers.

d) The following matrix shows the division of responsibility for MOD and ED physician for critical test reporting:

Inpatients Outpatients Business Hours

1. Contact Attending Provider

2. Contact Service Chief

3. Contact MOD

1. Contact Ordering Provider

2. Contact PCP

3. Contact Service Chief

After Business Hours

1. Contact Ordering Provider

2. Contact MOD

1. Contact MOD

2. Contact ED physician based on posted schedule

(10) Contract Laboratories: The Contract Laboratory identifying critical results will initiate direct communication to the ordering VA provider.

(11) Data collection for 14 day test results will be determined by QM and Patient Safety.

c. Communicating Test Results to Patients

(1) Appropriate therapeutic/treatment actions will be taken and documented in the medical record in response to critical test results/values and significantly abnormal tests.

(2) The communication of test results/values to the patient is defined as:

a) All tests requiring action must be communicated by the ordering provider or designee to patients no later than 7 calendar days from the date on which the results are available.

(designee may include PACT RN or PACT LPN as long as an LIP reviews the results and directs the communication and treatment plan).

b) Tests that require no action must be communicated by the ordering provider or designee to patients no later than 14 calendar days from the date on which the results are available. (Designee may include PACT RN, PACT LPN or MSA as long as an LIP reviews the results and directs the communication to the patient).

c) Depending on the clinical context, certain test results may require review and communication on shorter time-frames.

(3) Direct communication may be made face-to-face or by telephone.

(4) For telephone reporting of critical results, the complete test result must be verified by having the person receiving the information write it down and “read back” the complete results. The receiver of the information must then receive confirmation from the reporting person that the information is correct.

(5) The date, time, and mode of communication, along with the name of the person contacted will be documented in the medical record, either in the exam report or in a progress note.

(6) Discussion of the test results/values with the patient and/or authorized next-of-kin or legal guardian, as appropriate will be documented in CPRS.

d. Radiology Reporting:

(1) General:

a) All imaging studies will be ordered electronically.

b) Orders will not be accepted unless they indicate the reason for the study and the name of the ordering provider.

c) All imaging performed at the facility will be entered and verified in the electronic medical record.

(2) Critical Findings:

a) Critical results must be reported within a one (1) hour or sooner of the critical result findings by direct communication from the diagnostic practitioner, or surrogate, to the ordering practitioner or surrogate practitioner.

b) STAT Radiology tests will also be read within a one (1) hour time-frame.

c) Direct communication consists of a face-to-face meeting or telephone conversation.

d) Telephone communications are to be written down and “read back” by the individual receiving the imaging report.

e) The time and means of such communication and the name of the person contacted will be entered in the electronic medical record either as a note or within the study report.

f) Information will also be entered into the Log Book for tracking of the critical results.

g) If the ordering provider cannot be contacted, the report will be directly communicated to the radiology supervisor or designee who will contact the Service Chief. If the Service Chief cannot be reached or is not available, then the MOD will be contacted. The MOD will determine further actions.

h) Study findings that may require a change in patient management must be communicated by either direct documentation or by a preliminary report within 7 days.

i) The following matrix shows the division of responsibility for MOD and ED physician for critical imaging test reporting:

Inpatients Outpatients Business Hours

1. Contact Attending Provider

2. Contact Service Chief

3. Contact MOD

1. Contact Ordering Provider

2. Contact PCP

3. Contact Service Chief/MOD

After Business Hours

1. Contact Ordering Provider

2. Contact MOD

1. Contact MOD

2. Contact ED physician based on posted schedule

j) See Attachment D, E and F for critical values and the reporting algorithm.

(3) Nuclear Medicine:

a) All studies are sent to St. Louis Nuclear Medicine for interpretation by their radiologist.

b) Critical findings are communicated by telephone to the referring provider at Fort

Harrison within 1 hour of the interpretation.

c) This information is documented in their report following the impression.

d) The name of the provider or nurse they spoke to, the time of the communication, and the read back verification are documented in the report.

e) The provider at this facility will implement any action plan.

(4) Echocardiogram:

a) All studies are sent to Denver Cardiology Service for interpretation by their cardiologist staff.

b) “If any of the following abnormalities or any other findings that are deemed to require urgent medical action, are identified by the cardiologist interpreting the echocardiogram and there is no indication that the findings have already been communicated to the responsible inpatient provider or the PCP or their surrogate, the interpreting practitioner will contact the responsible treating provider by telephone within 30 minutes of reading the study and /or by electronic chart alert (not critical or life-threatening), and document the communication in the procedure report.”

c) If the same abnormalities are identified by the sonographer, prompt notification to the ordering provider will occur.

d) If the ordering provider cannot be reached then the MOD will be contacted. No more than a 15 minute time-frame should occur before contact is made.

e) The ordering provider or the MOD will determine the plan of care.

f) Patients who appear to be in acute distress including pallor, shortness of breath, diaphoresis, chest discomfort, or other signs/symptoms that require immediate professional evaluation will be transported to the ED for further care.

g) See Attachment E for the Listing of Echocardiogram Critical Test Results

d. EKG:

(1) After the EKG is completed, the results are scanned into MUSE.

(2) During and immediately after, if the staff person notes a critical abnormal finding, the provider is notified within 15 minutes.

(3) The ordering provider will then determine further action(s).

(4) The Ordering provider is to read the EKG within 7 days.

(5) Once it is read, it is automatically uploaded into CPRS.

(6) The Cardiopulmonary Supervisor will monitor the test completion data. Data will be collected and reported to the Patient Safety Committee.

(7) See Attachment E for the EKG Critical Test Results List.

e. Mammogram:

(1) Mammography imaging is done within a local community.

(2) Results are reported to the ordering provider.

(3) The ordering provider communicates the results of Breast Imaging Reporting and Data System (BI-RADS) Code categories 0,3,4,5,6 findings to the patient.

(4) All tests requiring action must be communicated by the ordering provider or designee to patients no later than 7 calendar days from the date on which the results are available.

(5) Tests that require no action must be communicated by the ordering provider or designee to patients no later than 14 calendar days from the date on which the results are available.

(6) Depending on the clinical context, certain test results may require review and communication on shorter time-frames that minimizes the risk to the patient.

f. Monitoring:

Reporting of the monitoring of test results will be done on a quarterly basis to QM and/or Patient Safety. to Providers and Patients. National Center for Patient Safety- National Patient Safety Goal #2

5. DEFINITIONS

Ordering Practitioner: Is a practitioner authorized to enter and sign orders for diagnostic tests by privileges or acting under a scope of clinical practice.

Diagnostic Practitioner: Is a practitioner who performs or supervises the performance and interpretation of diagnostic tests by rights of licensure.

Designee: Is a clinical team member authorized by the ordering provider who acts on behalf of the ordering provider to receive information from the diagnostic provider (in the absence of the ordering provider) and/or notifies patients of test results in a timely manner and discusses such results with the patients, in accordance with this policy.

Personal Representative: Is a person, who under applicable law, has authority to act on behalf of the individual. This may include power of attorney, legal guardianship of an individual, the executor of the estate of a deceased individual, or someone under Federal, state, local, or tribal law with such authority.

Patient Notification: Is communicating test results to patients or, if appropriate, to their personal representatives, including additional context and follow-up action as needed.

Patient notification could occur through any direct or indirect method. For certain types of tests and certain types of patients, the direct methods are preferred.

Indirect Communication: Is communication when parties involved are not present at the same time, such as electronic notifications in Computerized Patient Record System (CPRS), secure messaging, FAX, or letter.

Direct Communication: Is the communication of test results when all parties are present at the same time, such as in person, per telephone conversations, a hand carried report, or Clinical Video Telehealth (CVT).

Test Results: Include the results of laboratory and pathology testing, diagnostic imaging, and diagnostic procedures.

Normal Test Results: Is a diagnostic finding that falls within the normal reference range for the test and may or may not require immediate action or change in treatment depending on clinical circumstances. (Example: a patient on Warfarin whose international normalized ratio [INR] is subtherapeutic but in the normal range.)

Abnormal Test Results: Are results that fall outside a specified normal reference range, are unexpected, or could indicate the presence of disease. An abnormal test may or may not require action and therapeutic intervention, depending on the clinical context. (See Critical Value and Clinically Significant Results below.)

Clinically Significant Test Results: Is a diagnostic finding that requires attention by the ordering practitioner, but not necessarily in an immediate time-frame.

Critical Laboratory Tests and Results: Is one that is ordered STAT due to the urgent clinical need. Laboratory tests ordered STAT require that testing and reporting in CPRS will be completed in one (1) hour or less. A list of these tests orderable STAT is found in ATTACHMENT C to this policy.

a. Critical Lab Tests (STAT) sent to contract laboratories are completed within one (1 hour) of sample receipt. This time-frame is identified in the contract.

Radiology STAT tests: are to be completed and reported within a one (1) hour time-frame.

6. Critical Radiology Findings: are critical radiology results that are reported within one (1) hour of the exam or as soon as possible.

7. REFERENCES

1. VHA Directive 1088. October 7, 2015 (Amendment January 24, 2022

2. Communication of Test Results Toolkit SharePoint Site:

https://dvagov.sharepoint.com/sites/VACOCHADUSHOM/10NC/10NC3/CTR/def ault.aspx

3. VHA Handbook 5005/53, Medical Support Assistant (MSA) GS-0679 Qualification Standards

4. VHA Handbook 1400.04, Supervision of Associated Health Trainees

5. VHA Handbook 1605.1, Privacy and Release of Information

8. RESCISSION

MCP 11-19-148, 10/01/2018

9. Attachments:

a. Laboratory Critical Values

b. Pathology & Microbiology Critical Values

c. P&LMS STAT Tests

d. Radiology Critical Exams and Critical Results

e. Notification Algorithm

10. REVIEW

This MCP for Communicating Test Results to Providers and Patients is required to be reviewed during recertification, 5 years from the effective date or when changes occur to the governing document.

https://dvagov.sharepoint.com/sites/VACOCHADUSHOM/10NC/10NC3/CTR/default.aspx https://dvagov.sharepoint.com/sites/VACOCHADUSHOM/10NC/10NC3/CTR/default.aspx

11. RECERTIFICATION

This MCP is scheduled for recertification on or before the last working day of April 2027.

This MCP will continue to serve as local policy until it is recertified or rescinded. In the event of contradiction with national policy, the national policy supersedes and controls.

12. SIGNATORY AUTHORITY

Judy Hayman, Ph.D.

Executive Director, Montana VA Health Care System

Date Approved: April 6, 2022

NOTE: The signature remains valid until rescinded by an appropriate administrative action.

DISTRIBUTION: MCP Facilitator notifies staff monthly of all new, updated, or rescinded MCPs by sending to all staff. MCP Owners should distribute to staff accordingly.

MCPs are stored here within the MTVAHCS Document Control System:

https://dvagov.sharepoint.com/sites/VACOHRSCEAST/monvamc/default.aspx

Attachment A:

DEPARTMENT OF VETERANS AFFAIRS

https://dvagov.sharepoint.com/sites/VACOHRSCEAST/monvamc/default.aspx

PATHOLOGY AND LABORATORY MEDICINE SERVICE

VA Montana Healthcare System

LABORATORY CRITICAL VALUES

INCLUSIVE RANGES – LAST UPDATE = 03/04/2020

AREA TEST CRITICAL LOW CRITICAL HIGH

Chemistry BUN, serum none 100 mg/dl Calcium, serum 6.0 mg/dl 12.5 mg/dl Creatinine, serum None 6.0 mg/dl Glucose, serum 50 mg/dl 400 mg/dl Magnesium, serum 1.2 mg/dl None Potassium, serum 3.0 mEq/L 6.0 mEq/L Phosphorous, serum

1.0 mg/dl None

Sodium, serum 125 mEq/L 160 mEq/L Troponin-I, serum None 0.04 ng/ml

Coagulation Prothrombin time None 5.0 INR aPTT None 180 seconds D-Dimer None 501 ng/mL

Hematology Hematocrit 25% None Hemoglobin 8.0 g/dl None WBC, blood 2,500/cmm 20,000/cmm Neut, Absolute

(blood)

1.0 K/ul None

WBC, CSF None 6/cmm Platelet count 50,000/cmm 800,000/cmm PMN Abs Count, Ascites fluid none 250/cmm

Blood Gases PCO2, venous/ arterial blood 20 mmHg 60 mmHg

PO2, arterial blood 50 mmHg None pH, arterial blood 7.26 7.54 Bicarbonate

(HCO3) 10 mmol/L 40 mmol/L pH, venous blood 7.25 7.55 Therapeutic drugs

Acetaminophen None 150 ug/ml

Amikacin, trough None 5 ug/ml Amikacin, peak None 29 ug/ml Carbamazepine None 12.1 ug/ml

Digoxin None 2.0 ng/ml Dilantin None 20 ug/ml Gent & Tobra, trough None 2.0 ug/ml

Gent & Tobra, peak None 15.0 ug/ml Lithium None 1.2 mEq/L Phenobarbital None 40 ug/ml Quinidine None 5 ug/ml Salicylates None 30.0 mg/dl Theophylline None 20ug/ml Valproic acid None 151 ug/ml Vancomycin trough None 20 ug/ml Urinalysis Casts, urine (waxy, cellular) None any/LPF

Attachment B:

1. Anatomic Pathology Values:

Any new malignancy. These are phoned to the provider.

2 VA Healthcare Montana Microbiology Critical Values

ANY POSITIVE CSF GRAM STAIN OR CULTURE

INSTRUMENT POSITIVE BLOOD CULTURE GRAM STAIN

ANY EYE CULTURE WITH GRAM NEGATIVE ROD/GRAM POSITIVE ROD ON

GRAM STAIN OR ISOLATED IN CULTURE

GRAM NEGATIVE OR GRAM POSITIVE ORGANISMS NOTED ON GRAM STAIN

OF BLOOD UNIT (FFP, PLT OR RBC’S) IMPLICATED IN TRANSFUSION

REACTION

MULTI-DRUG RESISTANT ORGANISMS INCLUDING BUT NOT LIMITED TO;

MRSA, VRE, EXTENDED SPECTRUM BETA-LACTAMASE AND

CARBAPENEMASE PRODUCING GRAM NEGATIVE RODS.

C.DIFFICILE COMMON ANTIGEN AND TOXIN POSITIVE BY EIA OR PCR

POSITIVE AFB SMEAR OR M. TUBERCULOSIS ISOLATED FROM CULTURE

SELECT AGENT ORGANISMS INCLUDING BUT NOT LIMITED TO; YERSINIA

PESTIS, FRANCISELLA SP., BURKHOLDARIA SP., BACILLUS ANTHRACIS

Attachment C: P&LMS STAT TESTS. Updated 7/23/20

ACETAMINOPHEN

ALBUMIN

ALKALINE PHOSPHATASE

AMYLASE

AMYLASE, URINE

ARTERIAL BLOOD GASES

BILIRUBIN, TOTAL

BLOOD CULTURE, ACUTE SEPSIS

BLOOD CULTURE, R/O CATH-RELATED

SEPSIS

BLOOD CULTURE, R/O ENDOCARDITIS

CALCIUM

CARBOXYHEMOGLOBIN

CARDIAC PANEL

CBC PROFILE WITH AUTODIFF

CELL COUNT (CSF)

CELL COUNT (PERICARDIAL FLUID)

CELL COUNT (PERITONEAL FLD)

CELL COUNT (PLEURAL FLUID)

CELL COUNT (SYNOVIAL FLUID)

CHEM PROFILE (14 TESTS)

CHEM PROFILE, MINI (8 TESTS)

CHEM/LIVER

CHLORIDE

CHOLESTEROL

CK-MB MASS

CO2

LIVER FUNCTION PROFILE

LYTES

MAGNESIUM

NT-proBNP

OCCULT BLOOD CARD TEST

OCCULT BLOOD, GASTRIC

PH

PHENOBARBITAL, SERUM

PLATELET CT

PO4

POTASSIUM

PREGNANCY TEST, URINE (QUAL)

PROTEIN, CSF

PROTEIN, TOTAL

PROTEIN, URINE 24HR

PROTEIN, URINE RANDOM

PT & PTT

PTT

PTT

QUINIDINE

RENAL PANEL

SALICYLATE

SGOT

SGPT

SODIUM

SODIUM (ARTERIAL)

CPK

CREATININE

CREATININE EGFR PANEL

CT SCREEN

D-DIMER

DIC PANEL

DIFF COUNT (BLOOD)

DIFF COUNT (FLUID)

DIGOXIN

DILANTIN

ETHANOL

FIBRINOGEN

GAMMA GT

GENTAMICIN

GLUCOSE

HCG-BETA SUBUNIT SERUM, (QUANT)

HGB & HCT

HIV RAPID, WHOLE BLOOD

IONIZED CALCIUM (VENOUS)-STAT FH ONLY

LACTIC ACID

LACTIC ACID, CSF

LDH

LIPASE

LITHIUM

T-4

THEOPHYLLINE

TOX SCREEN FH INHOUSE

TRIGLYCERIDE

UREA NITROGEN

URIC ACID

URINALYSIS (IRIS)

VALPROIC ACID

VENOUS BLOOD GAS

WBC

Attachment D: Radiology Critical Tests and Exams

1. Radiology Critical Exams:

a. Results of these tests are to be communicated to the provider, whether normal or abnormal.

(1) Ectopic Pregnancy

(2) Aortic Rupture or Leak

(3) Testicular Torsion

2. Radiology Critical Results:

(1) Results require direct communication within 1 hour of the exam.

(1) Cerebral Hemorrhage/Hematoma

(2) Brain Tumor with mass effect

(3) Depressed Skull Fracture

(4) Spinal Cord Compression

(5) Discitis

(6) Carotid Artery Dissection

(7) Tension Pneumothorax

(8) Aortic Dissection, if not chronic

(9) Pulmonary Embolism

(10) Impending Aneurysm Rupture

(11) Ruptured Aneurysm

(12) Free air in the abdomen (if not recent surgery, feeding tube, or other drain)

(13) Appendicitis

(14) Portal Venous Air

(15) Volvulus (if definite, not “can’t rule out”)

(16) Mediastinal Emphysema

(17) Acute Traumatic Visceral Injury

(18) Retroperitoneal Hemorrhage

(19) Ectopic Pregnancy

(20) Testicular Torsion

(21) Ovarian Torsion

(22) Deep Venous Thrombosis (acute, not chronic)

(23) Significant line/tube misplacement

Attachment E:

1. Nuclear Medicine Critical Tests/Results:

a. The major tests that could lead to a critical result in nuclear medicine are:

1) Myocardial perfusion

2) Multigated cardiac acquisition (MUGA)

3) Pulmonary ventilation/perfusion

4) Hepatobiliary

b. “These tests can be sometimes associated with likelihood of a short-term poor outcome and require either immediate therapeutic intervention or close monitoring.”

2. Echocardiogram Critical Test Results:

a. Hear Rate > 130 bpm

c. Heart Rate < 40 bpm

d. Other suspected serious cardiac arrhythmia

e. Valvular regurgitation

f. Mobile or pedunculated intracardiac thrombus

g. Severe valvular stenosis or insufficiency not previously identified or diagnosed

h. Pericardial effusion with evidence of tamponade

3. EKG Diagnostic Critical Test Results/Values:

a. St elevation indicating a Myocardial Infarction

b. St segment elevation consistent with acute myocardial injury or infarction.

c. Ventricular Tachycardia

d. Heart Rate <30 or 3rd degree AV block

e. Mobitz Type II 2nd degree AV block

f. Heart Rate >200

g. Sinus pause > 3 seconds

Attachment F: Reporting of Critical Results

No CriticalValue Yes

Test area will contact ordering/attending provider to report value

Reached within 15minutes No

Yes

Diagnostic Info reported

Read back verification

Documentation in CPRS

For Radiology enter into Log Book

Action Plan/Treatment per responsible provider

Contact the patient about test results

Contact ordering or attending again within 15 minutes

Reported within 1 hr

Contact Service Chief, MOD, ED

No

No

Contact Other staff

Abnormal: within 7 days Normal: within 14 days

Report to