Implementation of a Closed-Loop Reporting System for Critical Values and Clinical Communication in Compliance with Goals of The Joint Commission

Abstract

Background: Current practices of reporting critical laboratory values make it challenging to measure and assess the timeliness of receipt by the treating physician as required by The Joint Commission’s 2008 National Patient Safety Goals. Methods: A multidisciplinary team of laboratorians, clinicians, and information technology experts developed an electronic ALERTS system that reports critical values via the laboratory and hospital information systems to alphanumeric pagers of clinicians and ensures failsafe notification, instant documentation, automatic tracking, escalation, and reporting of critical value alerts. A method for automated acknowledgment of message receipt was incorporated into the system design. Results: The ALERTS system has been applied to inpatients and eliminated approximately 9000 phone calls a year made by medical technologists. Although a small number of phone calls were still made as a result of pages not acknowledged by clinicians within 10 min, they were made by telephone operators, who either contacted the same physician who was initially paged by the automated system or identified and contacted alternate physicians or the patient’s nurse. Overall, documentation of physician acknowledgment of receipt in the electronic medical record increased to 95% of critical values over 9 months, while the median time decreased to <3 min. Conclusions: We improved laboratory efficiency and physician communication by developing an electronic system for reporting of critical values that is in compliance with The Joint Commission’s goals.

Read-back improves information transfer in simulated clinical crises

“…Most research on read-back in healthcare has involved non-emergency situations 20 21. We found no studies quantifying the impact of read-back on effective information transmission between sender and receiver in the context of a clinical emergency.…”

Assessing Clinical Laboratory Quality: A College of American Pathologists Q-Probes Study of Prothrombin Time INR Structures, Processes, and Outcomes in 98 Laboratories

“…Fully automated systems for notification of critical results can reduce the number of times physicians are unable to receive results and are now being used in a few institutions. 24,25 Documentation was defective in 6.7% of critical value calls with read back, the name of the person receiving the results, the result elements, and the title of the person receiving the results not being recorded. These errors also can be reduced with re-education of both the laboratory staff and those approved to receive results about how important it is to follow policies.…”

Critical Value Reporting in Transfusion Medicine

“…Studies have shown success using automated electronic notification systems to alleviate the laboratory workload burden and ensure timelier delivery of results. 20,32 However, these systems may not satisfy requirements that the critical value was received by the patient caregiver, and the use of these systems for blood bank results is not mentioned. Limitations in this study include biases inherent to survey data as well as sample size.…”