Critical Values
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Questions and Answers

What is the consequence of failure to act on abnormal test results for patients?

  • Increased patient trust
  • Reduced legal liability
  • Decreased healthcare costs
  • Loss of opportunity to begin treatment (correct)

    • What is the objective of reporting critical results of tests and diagnostic procedures?

  • To reduce healthcare costs
  • To assign legal liability to providers
  • To provide the responsible licensed caregiver these results within an established time frame so that the patient can be promptly treated (correct)
  • To provide results to patients within an established time frame

    • What is the significance of establishing explicit time frames for reporting test results?

  • It reduces the workload of healthcare providers
  • It increases legal liability for providers
  • It ensures timely and reliable communication of test results (correct)
  • It decreases patient satisfaction

    • What is the purpose of identifying who should receive the results of diagnostic tests?

    <p>To ensure that critical results are reported to the responsible licensed caregiver</p> Signup and view all the answers

    What is the consequence of failure to act on abnormal test results for providers and health systems?

    <p>Legal liability, loss of patient trust, and unnecessary costs</p> Signup and view all the answers

    What was the medical condition that the patient in the first case suffered from after reacting to angiogram dye?

    <p>Status epilepticus</p> Signup and view all the answers

    Why is it important to establish a shared policy for uniform communication of all types of test results?

    <p>To ensure timely and reliable communication of test results</p> Signup and view all the answers

    What is the goal of reporting critical results of tests and diagnostic procedures on a timely basis?

    <p>To provide the responsible licensed caregiver these results within an established time frame</p> Signup and view all the answers

    Why should critical values be created for EEG/cEEG?

    <p>To provide the responsible licensed caregiver critical results within an established time frame</p> Signup and view all the answers

    What was the EEG tech doing when Charles Gray had a recorded seizure?

    <p>Taking a break</p> Signup and view all the answers

    What was the purpose of the serial EEGs in the first case?

    <p>To monitor the patient's seizures</p> Signup and view all the answers

    What is the critical value for calling a reading neurologist in remote cEEG monitoring in the ICU?

    <p>New onset of seizure or significant change from baseline EEG</p> Signup and view all the answers

    Why would STAT reporting of results be necessary for a patient admitted with a subdural hematoma?

    <p>To identify potential harm if results are withheld</p> Signup and view all the answers

    What is an indication for calling a bedside care provider in remote cEEG monitoring in the ICU?

    <p>Patient may be at risk for physical injury</p> Signup and view all the answers

    Why would a patient post-op from a thoracic abdominal aneurysm repair require STAT reporting of results?

    <p>To identify potential harm if results are withheld</p> Signup and view all the answers

    What is an example of a critical value in remote cEEG monitoring in the ICU?

    <p>Seizure lasting &gt; 5 minutes</p> Signup and view all the answers

    Why would STAT reporting of results be necessary for a patient admitted with cardio-pulmonary arrest?

    <p>To identify potential harm if results are withheld</p> Signup and view all the answers

    What is a critical value for calling a reading neurologist in remote cEEG monitoring in the ICU?

    <p>New type of seizure</p> Signup and view all the answers

    Why would a patient admitted with a subdural hematoma require STAT reporting of results?

    <p>To identify potential harm if results are withheld</p> Signup and view all the answers

    What should the Remote RT do if the patient has a seizure lasting greater than X minutes?

    <p>Call the Designated In-Home Companion and the Physician</p> Signup and view all the answers

    What is the primary concern when the patient has a seizure?

    <p>The patient's safety and risk of physical injury</p> Signup and view all the answers

    What should the Remote RT do if the patient has X number of seizures in 1 hour?

    <p>Call the Designated In-Home Companion and the Physician</p> Signup and view all the answers

    Why should the Remote RT call the Designated In-Home Companion?

    <p>If the patient may be at risk for physical injury</p> Signup and view all the answers

    What is the purpose of event follow-up after a seizure?

    <p>To ensure the patient's safety and well-being</p> Signup and view all the answers

    What should the Remote RT do if the patient has a second generalized tonic/clonic seizure in a short period of time?

    <p>Call the Designated In-Home Companion and the Physician</p> Signup and view all the answers

    Why is it important for the Remote RT to monitor the patient's seizures?

    <p>To ensure the patient's safety and well-being</p> Signup and view all the answers

    What is the primary role of the Designated In-Home Companion?

    <p>To ensure the patient's safety and well-being</p> Signup and view all the answers

    What is the primary objective of establishing a critical value policy for EEG testing?

    <p>To ensure timely communication of abnormal test results to healthcare providers</p> Signup and view all the answers

    What is the recommended approach to setting up a critical value policy for EEG testing?

    <p>Collaborating with key stakeholders to establish clear guidelines and procedures</p> Signup and view all the answers

    What is the primary benefit of using technology to establish and document EEG critical values?

    <p>Reducing the risk of human error in critical value detection</p> Signup and view all the answers

    What is the purpose of specifying the time between detection and notification of EEG critical values?

    <p>To ensure that healthcare providers are notified of critical values in a timely manner</p> Signup and view all the answers

    What is the recommended approach to communicating EEG critical values to healthcare providers?

    <p>Using secure messaging templates to notify providers of critical values</p> Signup and view all the answers

    What is the purpose of establishing monitoring activities and evaluation procedures for EEG critical values?

    <p>To optimize the quality of EEG testing services</p> Signup and view all the answers

    What is the primary benefit of using order sets to establish and document EEG critical values?

    <p>Streamlining the communication of critical values to healthcare providers</p> Signup and view all the answers

    What is the primary goal of reporting EEG critical values in a timely manner?

    <p>To improve patient outcomes by enabling prompt medical intervention</p> Signup and view all the answers

    Study Notes

    Safe Practice Recommendations

    • Identify who should receive test results and when the ordering provider is not available
    • Define what test results require timely and reliable communication
    • Identify when test results should be actively reported to the ordering provider and establish explicit time frames for this process
    • Establish a shared policy for uniform communication of all types of test results to all recipients

    Failure to Act on Abnormal Test Results

    • Failure to act on abnormal test results is a common medical error with potentially serious consequences
    • For patients, it can mean a loss of opportunity to begin treatment
    • For providers and health systems, the outcome can be legal liability, loss of patient trust, and unnecessary costs

    Goal 2: Improve Communication Among Caregivers

    • Report critical results of tests and diagnostic procedures on a timely basis
    • Critical results of tests and diagnostic procedures fall significantly outside the normal range and may indicate a life-threatening situation
    • The objective is to provide the responsible licensed caregiver with these results within an established time frame so that the patient can be promptly treated

    EEG Critical Values

    • EEG critical values are necessary to ensure timely and effective communication of abnormal test results
    • Lack of EEG critical values can lead to serious consequences, including legal liability and patient harm
    • Examples of patient harm include:
      • Failure to treat status epilepticus, resulting in permanent brain injury and a $4 million lawsuit
      • Failure to monitor a patient, resulting in a seizure and death
    • Failure to establish and communicate EEG critical values can lead to legal liability
    • Examples of legal cases include:
      • A $4 million lawsuit for failure to treat status epilepticus
      • A lawsuit against a hospital for failure to properly monitor a patient, resulting in death

    Critical Values for Remote cEEG Monitoring

    • Call a reading neurologist if:
      • New onset of seizure
      • Significant change from baseline EEG
    • Call a bedside care provider if the patient may be at risk for physical injury
    • Examples of patients who may benefit from STAT reporting of results include:
      • A patient with a subdural hematoma and mental status changes
      • A patient with cardio-pulmonary arrest and lip twitching
      • A patient post-op from a thoracic abdominal aneurysm repair with right-sided weakness

    Other Actions for Remote Technologists

    • End-of-episode documentation
    • Modified from Osburn & Lau, WSET 2009

    Critical Values for Remote RT Intermittent Monitoring of In-Home cEEG/AEEG

    • Call a designated in-home companion if:
      • Patient may be at risk for physical injury
    • Call a designated physician or in-home companion per protocol if:
      • Any time patient has a seizure lasting greater than X minutes
      • Any time patient has X number of seizures in 1 hour
    • Discuss options for event follow-up, including calling 911, calling 911 for a wellness check, or having the designated companion take the patient to the emergency room.

    Recommendations for Setting Up a Critical Value Policy

    • Terms should be clearly defined (i.e., what does "critical" mean?)
    • Responsibilities for all staff should be clear
    • The policy should be written by key stakeholders involved
    • The policy should specify the procedures for communicating abnormalities
    • The policy should specify the time between detection and notification
    • The policy should establish monitoring activities and evaluation procedures

    Additional Resources

    • Mission Health Critical Values Reporting Policy
    • CHMC Care Pathways: A User's Guide
    • Seattle Children's Hospital Clinical Standards Work Seizure Pathway

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    Related Documents

    Critical Values: To Alert or Not to Alert? PDF

    Description

    This quiz covers the guidelines for timely and reliable communication of test results, including identifying who should receive the results and establishing explicit time frames for reporting.

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