Improving communication of critical test results in a pediatric academic setting: key lessons in achieving and sustaining positive outcomes.

By applying the Institute for Healthcare Improvement's framework for strategic change (will, ideas and execution), The Hospital for Sick Children, in Toronto, Ontario, developed processes to improve patient safety through the effective communication of critical test results. In response to an adverse patient event, near misses and accreditation requirements, a task force with representatives from the laboratories and clinical services was established to ensure the timely and reliable communication of critical test results for biochemistry, hematology, coagulation, therapeutic drug monitoring and microbiology. The task force critically assessed processes and best practices, identified practical alternatives, tested changes, codified new processes in a hospital-wide policy and procedure and carried out post-implementation outcome audits. Lessons learned in sustaining improvements included the following: there is value in identifying strategies from a larger system perspective; there exist merits to working collaboratively as an inter-professional team (i.e., laboratory and clinical leaders); there is value in learning from failure; higher-cost but "higher-leverage" approaches can be pivotal; and regular monitoring and vigilance of policy compliance are required.