Urgent Notification of Critical Infectious Disease Test Results

Background: Critical values for infectious diseases represent qualitative diagnostic test results that indicate life-threatening conditions, prompting immediate clinician notification and potential life-saving intervention. However, infectious disease critical values vary substantially across U.S. hospitals, reflecting a lack of standardization in urgent notification practices.

Methods: We compiled microbiology, virology, parasitology, fungal, and antimicrobial resistance listings from 417 hospitals representing all 50 U.S. states and Washington, D.C., including university hospitals, trauma centers, community hospitals, and Centers of Excellence. Hospital critical values were compared with emerging infections, priority pathogens, select agents, and infectious threats identified by the CDC, WHO, NIH, and IDSA.

Results: Positive blood, cerebrospinal fluid, or sterile body fluid cultures appeared on 89.4% (373/417) of hospital notification lists, while Acid-Fast Bacilli (AFB) appeared on 59.0% (246/417). Common viral critical values comprised herpes simplex virus, 45.3% (189/417), and HIV, 24.5% (102/417). Malarial parasites and Cryptococcus species were listed by 51.3% (214/417) and 56.4% (235/417), respectively. Antimicrobial resistance critical values included vancomycin-resistant Enterococcus (15.8%, 66/417) and methicillin-resistant Staphylococcus aureus (12.7%, 53/417). Comparison of hospital critical values versus CDC, WHO, NIH, and IDSA pathogen classifications showed limited overlap with public health priorities. Although all four of these organizations deemed COVID-19 a serious threat, it appeared on only 4.1% (17/417) of hospital lists.

Conclusions: The national database revealed substantial variation in infectious disease critical values which emphasizes need for harmonization. Hospital recognition of emerging and high-priority public health threats was limited and surprisingly, COVID-19 was rarely listed. We recommend a dynamic model whereby hospitals review critical pathogens frequently and modify listings to increase urgent notifications that mitigate spread of disease when regional or national outbreaks occur. These findings highlight opportunities for improved communication, benchmarking, and standardization of infectious disease urgent notification practices in U.S. hospitals.