Critical Values, Critical Gaps: A Nationwide Assessment of Urgent Physician Notification in Pathology

Background: Critical limits are diagnostic findings that require urgent communication to physicians to ensure life-saving clinical intervention. This study investigated the national landscape of pathology critical value reporting protocols across six disciplines (surgical pathology, anatomic pathology, cytopathology, cytology, cytogenetics, and autopsy pathology) in U.S. hospitals.

Methods: Data were collected from 417 individual and network hospitals from across the United States via direct contact, and digital searches. Hospitals reporting at least one critical value within any of the six pathology categories were coded as “1” (presence), while hospitals without reported critical values were coded as “0” (absence). Frequencies of hospitals reporting for each pathology type were calculated at the national, regional, and state levels.

Results: Overall, 119 of 417 (28.5%) hospitals posted critical values for one or more of the six disciplines. The most frequent entries in surgical pathology (N=73), anatomic pathology (N=40), and cytopathology (N=35) were “malignancy in an uncommon location or specimen type” (20.5%, 15/73), “new or unexpected malignant diagnosis” (30.0%, 12/40), and “Malignant cells, body fluids” (28.6%, 10/35), respectively. Out of 417 surveyed institutions, the remaining 298 hospitals (71.5%) lacked any mention of pathology critical values. Geographic analysis revealed that critical value reporting was lowest in the West North Central, Mountain, and New England divisions, whereas the East North Central and West Pacific divisions demonstrated significantly higher reporting frequencies.

Conclusion: U.S. hospitals are required to list critical findings that merit urgent physician notification. Current U.S. urgent notification protocols are highly fragmented, leading to dangerous inconsistencies in the standard of care. Our recommendations include standardizing and publishing unified lists for urgent pathology notification, implementing Artificial Intelligence into Electronic Medical Records that will scour patient findings to alert physicians to critical cases, and requiring that values are reviewed, updated, and republished annually to reflect new changes in clinical practice.