Edmonton Zone

October 3, 2017 Laboratory Services Operational Update

Critical and Priority Request Definitions for Anatomical Pathology Samples

Key Messages Critical and Priority request definitions have been established for Anatomical Pathology samples for the province. Anatomical Pathology sites within Edmonton Zone rolled this out to endoscopy units in December 2016 and are now implementing these definitions to all areas.

The roll out will begin October 2, 2017. Background Education for hospital units will be incorporated with the education sessions being provided by Tech IIs for the new provincial AP requisition. Critical: Goal is to provide an initial report within 24 hours from received time in the laboratory (includes non-working days) if approved. The requesting physician MUST contact the appropriate Pathologist verbally to request CRITICAL processing and reporting and the pathologist must approve the request. Size of tissue sample and other factors may require additional processing time. This category is reserved for specimens such as:  Rapidly progressive renal failure  Rapid decompensation following a previous biopsy or surgical procedure of Uterus, Heart or Gastro-intestinal tract  Extensive desquamating skin disease  Undiagnosed masses causing anatomical compromise of vascular or nerve function  Transplant or immunocompromised patients with rapidly deteriorating clinical findings  Pediatric Tumors with immediate clinical/therapeutic consequences  Life-threatening infections

Priority: For other urgent cases- the initial report will be completed in less than the standard turnaround time

For more information, see the provincial document: Critical and Priority Request Definitions for Pathology Samples How this will impact you When a critical is requested:  The requesting physician MUST contact the appropriate Pathologist verbally to request CRITICAL processing and reporting and the pathologist must approve or decline the request  The requisition must be clearly labeled as a Critical 1  Must have supporting clinical history to indicate the reason for the request o Note: the approving Pathologist (or designate) can downgrade the request to priority if supporting medical information is not provided  Test request must include the physicians' direct contact information

When a priority is requested:  The requisition must be clearly labelled as a Priority– the new Anatomical Pathology Requisition has a check box for this  Must have supporting clinical history to indicate the reason for the request o Note: the approving Pathologist (or designate) can downgrade the request to routine if supporting medical information is not provided  The request may be approved by a Pathologist (or designate) upon receipt in the laboratory (this will be site dependent)  Test request must include the physicians' direct contact information Action Required Technical and Administrative staff:  Triage verbal requests for critical specimens to the appropriate resident/ pathologists (site specific)  Be aware of and follow the new critical and priority definitions  additional LIS and Vantage activities for tracking (site specific) Pathology staff:  Verbally approve or decline critical requests  Be available to provide a report to the clinician requesting the critical triaging within the 24 hour timeframe  Be aware of the critical request handling process at their site  Be aware of and follow the new critical and priority definitions Related Documents: Available on the AP Website under Edmonton Zone: http://insite.albertahealthservices.ca/8223.asp  Critical Request Process at RRL Sites  Critical Request Process at UAH  Critical Request Process Form-UAH Available on the AP Website under Anatomical Pathology Manual: http://insite.albertahealthservices.ca/8259.asp  Critical and Priority AP Samples Effective Date: October 2, 2017

Additional Information and Questions contact:  Site AP Technologist II  Jenny Zadunayski- EZ Anatomical Pathology Quality Assurance Tech II [email protected] 780-407-8481 This operational update has been approved by: Dr. Michael Mengel, Zone Clinical Department Head, Laboratory Services Edmonton Zone 2