Critical Values

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

Legal Consequences

• 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