The Concept and Application of Critical Diagnoses (Critical Values) in Anatomic Pathology

Occasional diagnoses in surgical pathology and cytology require immediate notification of the physician to potentially initiate rapid treatment or change management of the patient, similar to critical values (CVs) in clinical pathology. However, while CVs in clinical pathology are well established, the concept of CVs in anatomic pathology has not been presented until recently. Based on our recent studies determining the prevalence of CVs in surgical pathology and cytology, and the perceptions of pathologists and clinicians concerning the concept of CVs in anatomic pathology, the Association of Directors of Anatomic and Surgical Pathology conducted a survey of its membership. Based on the response, an Association of Directors of Anatomic and Surgical Pathology Committee developed national guidelines for critical diagnoses (CVs) in anatomic pathology that included diagnoses that can have immediate clinical consequences, unexpected or discrepant findings, and a variety of infections in immunocompromised and immunocompetent patients. These guidelines are meant to serve as a template, which can be customized at individual hospitals. It is now apparent that the concept of critical diagnoses in anatomic pathology is becoming established in the pathology community and is in fact included in the College of American Pathologists laboratory accreditation checklist. Following the Institute of Medicine’s report on medical errors, there have been an increasing number of initiatives to improve patient safety. We believe that similar to CVs in clinical pathology, having guidelines for anatomic pathology CVs will enhance patient safety and represent a practice improvement in anatomic pathology.