Understanding Critical Result Reports

• Understanding the Result Filter Trace – Which filter was applied to this result?

• Understanding the ADT Trace – How was the specialty, location, and attending doctor determined?

• Understanding the Escalation Trace – Which clinicians were alerted and how did they respond?

• Overview of Fields in the Critical Results Report (CRR)

Result Filter trace

The result filter trace shows which result filter was triggered to determine whether a result is considered critical. Below is an example of a result filter trace from the CRR:

Found 48 result filter(s) for LAB (285,264,276,270,268,265,292,307,295,284,288,296,282,280,297,274,741,304,277,303,293,287,281,301,298,278,289,279,300,266,299,286,799,302,269,273,271,267,294,275,290,291,878,306,308,272,283,740)
[0] Filtering by test codes
[0] 1 filters remaining (265)
[0] Filtering by ordered location: KCZ42 KCZ42
[0] [265] Matched on location: All Locations
[0] Accession number: 202503205038000699
[0] Procedure code: 8GLU
[0] Specimen source: 
[0] Specimen type: null
[1] Checking OBX 2038745. Code: GLU. Value: 30.0. NTE: null
[1] [265] Matched on code and value : GLU 30.0
[1] [265] All conditions match
[1] Total matches: 1

From the trace above, we are able to gather that:

• The system evaluated 48 result filters to check if the test was critical. Ultimately, it matched with filter 265, which was determined based on the ordered location and test code.

• The system then checked whether the test met the filter’s conditions (GLU = 30.0) and classified the result as critical.

ADT Trace

We use ADT trace to better understand the ADT we are receiving. If the information is available, the ADT gives us information on specialty, location and attending doctor. Our logic for understanding the ADT trace is as follows:

Inpatient patients

For inpatient patients, the system determines the patient's specialty and location using the following steps:

1. Latest ADT by Patient UIN:

   • Retrieve the latest ADT record received immediately before the result, using the patient's UIN.

   • If found, use the patient's location, specialty, and attending doctor from this record.

2. ADT by Visit Number:

   • If no ADT is found using the UIN, search for an ADT record using the visit number (which is generated per admission).

   • If found, use the patient's location, specialty, and attending doctor from this record.

3. ORU HL7 Results Message:

   • If no ADT records are found in steps (1) and (2), extract the patient's location, specialty, and attending doctor from the ORU HL7 results message.

Outpatient patients

For outpatient patients, the system determines the patient's specialty and location using the following steps:

1. ADT by Visit Number:

   • Search for the latest ADT using the visit number (which is generated per admission).

   • If found, use the patient's location, specialty, and attending doctor from this record.

2. ORU HL7 Results Message:

   • If no ADT is found in steps (1), extract the patient's location, specialty, and attending doctor from the ORU HL7 results message.

Below is an example of an ADT trace from the CRR:

Unable to find inpatient ADT for patientId=14488 institutionId=5
Patient is not IP, finding specialty, location, and AD by visit number: 100700024977
Found specialty code by visit number, 368660 - KSZDIA
Found location code by visit number, 368660 - KCZ42
Found AD by visit number, 368660 - 15957C
Using ADT location code KCZ42, isIp: null, adtLocationCode: KCZ42
Specialty (KSZDIA) from ADT, isIp: null
Attending dr (15957C) from ADT, isIp: null

From the trace above, we are able to gather that:

• We were not able to find an inpatient ADT hence this patient was an outpatient patient.

• Hence, we found the latest ADT by visit number, where we derived Specialty (KSZDIA) , Location (KCZ42) and Attending dr (15957C).

Escalation Trace and History

Escalation Trace

The escalation trace column give us information on which routing rule was activated and which clinicians are informed. Below is an example of escalation trace:

Ordering doctor with mcr number 15957C: 748 - *clinician name* - *clincian phone number* 
Attending doctor with mcr number 15957C: 748 - *clinician name* - *clincian phone number* 
Finding routing rule for specialty KSZDIA(KSZDIA) and location KCZ42(KCZ42)
Routing rule found:
Id: 73
Name: General Surgery
Specialties: All Specialities
Locations: All Wards
Day of week: weekday, using office hours: 2025-03-20 08:00:00 - 2025-03-20 17:00:00
Nowtime: 2025-03-20 10:54:59, using office hours rules
rosterAssignmentDate: 2025-03-20 00:00:00
useSameShiftRules: false
dateTimeOfficeHoursPeriod: during
useOfficeHoursEscalations: true
[P1] OD - 819 - *clinician name*  - M16219A - *clincian phone number*
[P2] AD - *clinician name*  - M15229A - *clincian phone number*

From the trace above, we can gather further information on routing rules:

• Name of routing rule triggered: General Surgery

• Office hours or After Office hours: weekday, using office hours: 2025-03-20 08:00:00 - 2025-03-20 17:00:00

• Who was alerted? : [P1] OD AND [P2] AD.

Escalation History

The Escalation History column provides details on how and when clinicians responded, as well as any manual intervention by the contact centre. Below is an example of the escalation history:

[2025-03-20 10:55:06] Escalated to manual intervention
[2025-03-20 10:55:05] P2: *clincian phone number* (M15229A) - *clincian phone number* responded not to pick up:"3"
[2025-03-20 10:55:00] P2: Alerted *clincian phone number*(M16219A) - *clincian phone number*
[2025-03-20 10:54:59] P1: *clincian phone number* (M16219A)-*clincian phone number* responded not to pick up:"3"
[2025-03-20 10:54:59] P1: Alerted *clincian phone number*(M16219A) - *clincian phone number*

From the trace above, we can gather information such as:

• Both P1 and P2 replied with "3", hence indicating that they will not be acknowledging the result and acting upon it.

• Therefore, the critical alert was escalated to manual intervention for their action.

Overview of the CRR fields

Field	Meaning
HL7 Timestamp	MSH timestamp of critical result
Created at	This is the time when the critical alert was triggered
Lab type	We will display Biochemistry, ECG, Haematology, Microbiology or Radiology
Patient	We will display patient details, e.g visit number, patient specialty
Result Info	We will display details, e.g accession no., procedure and specimen code (if applicable)
Result Test Details	Specific details of the result
Result Ordering Dr	Details of the Ordering doctor, retrieved from results HL7 message, specifically: LIS & others - OBR 16.1 || Beaker & RIS - ORC 12.1.
Result Order Location	Details of the Ordering location, retrieved from results HL7 message, specifically: ORC 13
Escalation Status	We will display either Not Picked Up, In Progress, Acknowledged, or Closed. Refer here for more details on the status.
Escalation Ack Time	Timestamp at when the result was acknowledged
Turnaround Time (mins)	Time taken for result to be acknowledged
Escalation Ack Type	We will display whether the result was ack Auto (by Rooster) , Manual (by manual intervention) or by EPIC
Escalation Ack By	Clinician who had acknowledged the critical alert
Escalation Closed Time	Timestamp at when the result was closed by system
Escalation Closed Reason	The alert was automatically closed by the system due to routing rule configurations. E.g, configured to skip manual intervention
Escalation History	As explained above, it is the history of what the clincians have responded to the critical alert
Escalation Attending Dr	Attending doctor extracted from ADT
Escalation Specialty	Patient specialty extracted from ADT
Escalation Location	Patient location extracted from ADT
Manual Intervention	Details of clinicians and contact center staff who manually intervened in handling a critical alert
Message content	content of the message that was triggered to the clinician
Result Filter Trace	As explained above, it provides the trace of which result filter was matched to the incoming test result
ADT Trace	As explained above, it provides information on how we extracted information from the latest ADT received
Routing Rule Trace	As explained above, it provides information of which routing rule was triggered for the critical alert