Source: Briefings on The Joint Commission, August 1, 2009
Editor's note: WendySue Woods, RN, MHSA, CSHA, is a senior consultant at The Greeley Company, a division of HCPro, Inc., in Marblehead, MA. Each month in Briefings on the Joint Commission, an expert from The Greeley Company discusses a hot-button topic or challenging issue facing hospitals in the areas of accreditation, survey preparation, and more.
On May 12, The Joint Commission released proposed changes to the National Patient Safety Goals (NPSG), effective in 2010. The Joint Commission collected feedback on these proposed changes through June.
One of the most problematic and frequently cited NPSG elements of performance (EP) is NPSG.02.01.01, which addresses how organizations handle reporting of critical test results to physicians.
In 2006, based on The Joint Commission's annual report, only 61.4% of the organizations surveyed saw improvement in effectively communicating results deemed critical to patient care. Since its addition as an EP related to NPSG 2, effective communication, organizations have struggled to define "the list," establish reasonable reporting time frames, determine documentation strategies to facilitate data collection, and improve the reporting of this critical information to advance patient care.
The one issue misunderstood by so many of our clients was the distinction the goal required in a critical test and a critical result.
This idiosyncrasy was often missed completely and therefore found noncompliant.
The proposed changes to this NPSG bring the focus back to where it belongs: the patient. The goal's previous seven requirements have been reduced to two. The proposed changes now reflect the reporting of critical results.
Review the list:
- Assemble a team from each area that needs representation. Ensure that medical staff members are kept aware of the proposed changes. Keep it simple.
- Define which results are considered critical. According to Merriam-Webster's online dictionary, the definition of critical is "being or relating to an illness or condition involving danger of death." Using this definition should help you redefine your list. All patient test or diagnostic procedure results should be reviewed and placed into context with the current health and disease process. However, not all of these results can be considered a marker indicating a danger of death. Laboratory panic values are appropriately titled; however, providers of care typically agree that a panic value, although needing timely attention, does not always indicate danger of death.
- Consider making critical results a subset of the panic values requiring a higher level of reporting priority. Remember to address situations in which results that would be critical for most patients are not critical for a particular patient or for patients with a particular diagnosis. Also, improving results can be handled differently. Apply the same methods to diagnostic test results.
Who gets the call?
- Define who can receive this critical information and to whom it can be reported. The language of responsible caregiver is gone.
- Use your current data to determine what has worked effectively in the past. Review how this information is communicated and redefine as needed. What would make this process more reasonable and still ensure or improve consistency, accuracy, and timeliness? Is it reasonable to have the unit clerk take the message? Is it more effective to allow the office nurse to receive the information and seek out the physician? The current FAQs indicate the important issue is getting the information to the right person to avoid delays in treatment. Once the receiver of the information clearly understands the significance of the information being shared and the time frame in which it needs to be acted upon, patient safety can be ensured. You have almost five years of data and knowledge of what has and has not worked. If the past has proven that finding the right person to report the information to has been problematic, make changes that would make sense and ensure safe care.
Define the time:
Once again, you will have close to five years of data to review. If you have defined your list well, and danger of death is closely associated with the reportable list, defining this time frame should be reflective of the immediacy of the need to treat and care for the patient.
Do the PI:
Perform process improvement to evaluate the effectiveness of reporting the results in a timely manner in response to these critical results. Determine where the process is failing and why.
We have seen so many organizations focus on the sticker, the log, the note, etc., that the immediacy of patient needs is lost. On an interesting note, this NPSG does not require any documentation of this detailed process in the medical record.
What is expected is the ability to discern from the record that a critical result was received and an appropriate response or action occurred.
Perform the due diligence. Take time over the next few months to review your process and practice to see how they measure up to the proposed revisions.
Will the proposed changes to this goal bring your organization back to the basics of responding to test results in an appropriate and timely manner? Do you have mechanisms in place making sure you are aware when the data indicates a need to reevaluate and improve? We believe these changes help direct energies where they belong: keeping the patient safe.