Reporting Critical/Urgent/Significant Results in Anatomic Pathology: The Devil Is in the Details

Critical value reporting is an important facet of laboratory management and represents a significant potential challenge in patient care delivery, as well as a high-value target for quality improvement initiatives in both anatomic and clinical pathology settings. A recurring problem concerns successfully contacting unavailable health care providers with unexpected and/or time-sensitive results. We report a case of an incidentally detected and unexpected finding of tumor cells in a routine hip arthroplasty, in a patient under surgical management for a variety of chronic issues including peripheral arterial disease and traumatic fall. The abnormal result proved to be the first presentation of a widely disseminated metastatic melanoma. Although multiple associated health care providers were successfully contacted with the unexpected finding and acknowledged awareness of the concern for metastatic melanoma, one provider was not successfully contacted with the pathology result, leading to frustrations among multiple parties and a slight delay in appropriate patient referral. The sequence of events presents an opportunity to review standards of care regarding urgent diagnosis reporting in anatomic pathology and assess the published literature surrounding this issue.