Laboratory critical values policy bassett healthcare network. Critical results lab medicine a lab result from a pt that must be reported immediately to care provider, which may require urgent therapeutic action. Examination of the usefulness of repeat testing practices in. Host computer interface to be verified by qualified analyst. Critical values are called to the clinician responsible for the patient. Critical risk results an update on international initiatives ifcc. In these cases, written documentation must be produced for the laboratory to comply with this request. Critical lab value one that represents a pathophysiological state at such variance with normal as to be life threatening unless something is done promptly and for which some corrective action could be taken. Occasionally, a specimen may have a value considered to be a critical, or panic value. Critical tests always require rapid communication of results, whether normal or abnormal.
Pdf laboratory critical values policies and procedures. Critical value menus often include results that do not fit this definition, leading to highly variable practice in adult and pediatric laboratories. Critical values and results ordering and results mayo. A listing of laboratory values classified as critical is provided in the directory of services and laboratory policy manual.
Critical limits of laboratory results for urgent clinician notification professor dr lothar thomas kirschbaumweg 8, 60489 frankfurt email. Sepsis and the clinical laboratory alison woodworth, phd department of pathology, microbiology, and immunology. Aug 22, 2016 despite we would all agree that the timely and efficient communication of critical laboratory values is an unavoidable part of managed care and patient safety, worldwide harmonization of practices is expected to be a rather long and winding road. Policy for priority result reporting quest diagnostics. Critical values are defined as an analytic result that suggests a clinical condition that may be life. It is the policy of the clinical laboratory to call the critical values listed to a licensed provider as soon as completed and verified in compliance with hospital. It is the policy of the clinical laboratory to call the critical values listed to a licensed provider as soon as completed and verified in compliance with hospital policies approved by the lucile packard childrens hospital and stanford health care hospital boards of directors. To compare critical value policies and procedures, formulation of critical values list with critical values limits and monitoring tools, a webbased questionnaire was formulated for 389. When there are critical results, they will not be called to the nursing unit by the laboratory since the nurse is already aware of the results heshe obtained. Academy of acute care physical therapy apta task force. Of the analytes measured by the nhanes 20012002 lipid laboratory, the only one for which such a panic value.
A comment will be appended after the initial critical value is detected. Clinical laboratory critical value immediate notification test list chemistryhematology tests assay lower limit upper limit call if similar result within 2 days. Ammonia 110 umoll carbon dioxide 40 mmoll co carbon monoxide 25 %. Critical results may also be referred to as panic values. Listed below are the established critical limits for the hematology area.
Prompt verbal notification is provided to clients for results that are arupdefined critical values and require the immediate attention of a clinician. Critical results are communicated to the physician, the physicians representative, the ordering entity, or other clinical personnel responsible for patient care once the result has been verified and the patients result has been entered into the laboratory computer system. Test value comments detection of infectious agent in by blood positive culture, smear, rapid antigen, or nucleic acid test nat detection not speciation afb, bacterial, fungal, parasite except anaplasma, ehrlichia, and babesia bone marrow positive culture or smear afb, bacterial, fungal, viral, parasite body fluid. Critical value automatic callback mayo medical laboratories. Appendix b selected normal pediatric laboratory values 1449 growth hormone s2 after infancy fasting specimen. Critical limits of laboratory results for urgent clinician. The clinical laboratory does not currently define any tests as critical. Results exceeding these limits are flagged as critical in the laboratory information system lis and must be called to the patients caregiver. Legacy laboratory client services 503 41234 toll free 877 2705566 legacy laboratory services page 1 of 4 hematology age related reference ranges and critical values complete blood count and differential test gender age reference range critical value low high wbc 5. A critical value critical result is defined as a value result that represents a pathophysiological state at such variance with normal expected values as to be lifethreatening unless something is done promptly and for which some corrective action could be taken. Upon verbal notification from the referral laboratory of a critical value, import the template critref as an order comment on the appropriate order. Nurses are often tasked of patient preparation and specimen collection during these diagnostic procedures. Identify normal chemistry values for the adult patient. The date and time of such reporting shall be documented in the medical record.
Pathology consultation on reporting of critical values. The scope includes laboratory, radiology, and primary life services ekg, vascular, echocardiogram and. Priority value tables by testing department quest diagnostics priority result reporting appendix b effective march 9, 2020 qdmoq372 v6 page 3 of 9 replaces all previous versions infectious agents priority 1 called 24 hrs, 7 days priority 2 office hours, 7 days analyte age result age result aspergillus galactomannan antigen, serum. Critical or panic values are, by definition, potentially lifethreatening values. Critical values are any laboratory result which represents a pa thophysiologic state at such variance with normal as to be life threatening unless some action is taken in a very short time and in which the state may not be readily detectable or highly sus pected. Critical results will be called to the patients caregiver or physician. The following table represents generally accepted reference points that may create lifethreatening.
These values are sent from the nursing units to the emr electronic medical record. Clinical laboratory critical value immediate notification policy. The purpose of this list is to identify the laboratory tests and their respective critical high and critical low values results. Despite we would all agree that the timely and efficient communication of critical laboratory values is an unavoidable part of managed care and patient safety, worldwide harmonization of practices is expected to be a rather long and winding road. Critical limits for laboratory test values critical values will be reported only for tests that are ordered. Laboratory personnel will initiate notification of an appropriate caregiver physician, house staff, or nurse of any defined critical values. In the present study 1,187 critical values were analysed in the clinical chemistry laboratory catering to tertiary care hospital for neuropsychiatric diseases. Besides, there is no data comparing clinical outcomes between patients that have more reported critical values and those with just one reported critical value.
The clients current laboratory values are compared to the normal laboratory values, as above, in order to determine the physiological status of the client and to compare the current values during treatment to the laboratory values taken prior to a treatment. This policy defines the process for establishment of a critical value list for anmed health laboratory services and. But this is a pieinthesky view of critical value reporting practices. Critical value is defined as a result suggesting that the patient is in danger unless appropriate action is taken immediately. Pdf the critical values are the values of laboratory testing results which required attention or action by the physicians. This policy defines authorized staff that may accept critical values and provides a detailed calling algorithm. In order to assist the ordering physician in responding to certain potentially lifethreatening. Test critical value s units bacillus anthracis, culture, nucleic acid positive or antigen test afb culture, smear positive blood cultures positive brucella sp. Alerting of laboratory critical values springerlink.
After tests are completed, the results will go to the l. Laboratory staff are responsible for recognizing critical results and making appropriate notifications to physicians, clinicians, andor nursing staff. This learning guide is an essential primer to the basics of not only clinical chemistry but laboratory medicine. Please refer to intermountain laboratory services labnet cp0008a1 or contact client services 8015072110 or 8773531106 for the most current critical values list. Critical values are defined by the medical director of each technical section. Assessing the turn over time of critical value in hospitals. Priority value tables by testing department quest diagnostics priority result reporting appendix b effective march 9, 2020 qdmoq372 v6 page 4 of 9 replaces all previous versions infectious agents priority 1 called 24 hrs, 7 days priority 2 office hours, 7 days analyte age result age result malaria parasites or other blood parasites. Effective practices for the timely and accurate reporting. Critical value table michigan medicine laboratories mlabs has established critical values for the following tests. U glucose with u ketones any 250 mg or any positive test reducing substance 1,000 mg critical value automatic callback. A new call is made every 7 days if the value for the test continues to be critical.
We evaluated critical value reporting by test, laboratory specialty, patient type, clinical care. Intermountain laboratory services cp0008a1 817 salt lake city, utah page 1 of 2 laboratory critical values newborn defined as critical value exception applies only applies when not reported in conjunction with a hematocrit blood gases clinical lab cvs carboxyhemoglobin 7%. Dec 01, 2012 in an ideal world, all critical values would follow a single, clear definition and we would have simple, efficient ways to communicate with interested providers who respond quickly, she said. A panic value is a value that can reflect a lifethreatening problem if not attended to promptly. Laboratory personnel will initiate notification of an appropriate caregiver physician, house staff, or nurse of any defined. Laboratory criticalpanic value list stanford health care. Whenever a value falls outside the critical range and then becomes critical again, a new call is made. Which test results are considered critical values to accomplish the objectives given above, cutoff values for certain laboratory tests were determined based on. Critical value notification policy policy vi14 clinical laboratory critical value immediate notification policy subject immediate notification of critical values scope all lab sections version 11. Effective practices for the timely and accurate reporting of critical values. Reviewed critical value policy no labwaived testing 601001 obtain critical value test report or received call from laboratoryradiology personnel clarification of critical value test report to lab personnel. Laboratory critical values is updated to reflect current laboratory practice along with laboratory staff training and laboratory computer system updates to alert staff to a critical value that requires notification. Critical values and significant findings list critical values.
The purpose of this list is to identify the laboratory tests and their respective critical high and critical low valuesresults. Notify patient caregiver unless otherwise noted below. Questions will usually include critical lab values and its a matter of identifying if its within normal range or not. The joint commission requires that critical tests and critical results be reported and received by the appropriate caregivers in a timely manner. As a writer at nurseslabs, his goal is to impart his clinical knowledge and skills to students and nurses helping them become. Glucose levels 350 do not require a laboratory collection or testing in the central laboratory. Some testing areas may wish to phone some abnormal results, and these discretionary decisions have not been built into the critical value list. Comparing the clients laboratory values to normal laboratory values. Low values high values blood gas arterial blood gas, adult ph 7. Laboratory critical values policies and procedures. Documented critical value received in the patient care notes, using the critical value template, document. Mayo clinic laboratories critical values critical results list. The following documents describe mayo clinic laboratories policies for reporting critical values, critical results and semiurgent results, and lists the tests that are classified under each policy. Critical values are posted in the online laboratory handbook.
Develop written procedures for managing the critical results of tests and diagnostic procedures that address the following. The following is a list of critical values established at parrish medical center. Hematology age related reference ranges and critical values. He defined critical laboratory values as values which reflect pathophysiological derangements at such variance with normal as to be lifethreatening if therapy is not instituted immediately.
Arup laboratories defines critical values as any test result that may require rapid clinical attention to avert significant patient morbidity or mortality. This policy is applicable to all laboratories within marshfield labs laboratory service line. Critical values policy 18 critical value lists adult and childrennewborn 22 iv. Clinical laboratory critical value immediate notification. For inpatients, the laboratory calls critical values the first time the limit is exceeded. Crriittiiccaall vvaalluueess lliisstt renown health. Because all patients differ in both metabolic and physiologic makeup, no one list can be directly applicable to all patients and all situations. Pdf critical value of the clinical laboratory test in thailand. Jan 01, 2012 since the early 1970s, laboratory medicine specialists have used computer technology and automation to identify and confirm critical laboratory values. Critical value of the clinical laboratory test in thailand. Study of variables affecting critical value notification in a. Lundberg 1972 defined a critical value as a physiological state at such variance with normal as to be life threatening unless something is done promptly and for which some corrective action can be taken.
Critical values are those that require immediate notification of the designated caregiver for initiation of appropriate clinical intervention to avert significant patient morbidity or mortality. Some physicians or units may decline communication of critical values. Panic critical values labcorp defines critical panic results as laboratory test results that exceed established limits high or low as defined by the laboratory for certain analytes as listed in the critical panic limits. As of january 2020, oxford university press is no longer publisher of critical values on behalf of ascp find out more. Critical values are those associated with imminent danger unless acted upon promptly. Clinical laboratory critical value list parrish medical center. Chemistry critical values were developed and approved by valerie bush. Infectious disease test value comments detection of infectious agent in by blood positive culture, smear, rapid antigen, or nucleic acid test nat. Nov 26, 20 the objective of the study was to assess the variables affecting critical value notification, their role in affecting its quality and approaches to improve it. Critical panic values are defined as values that are outside the normal range to a degree that may constitute an immediate health risk to the individual or require immediate action on the part of the ordering physician.
Pediatric considerations in critical value assignment. Learning objectives after successful completion of this course, you will be able to. Critical value definition of critical value by medical. Critical laboratory tests and values ui health care. Critical values lists have been used for many years to decide when to notify physicians and other caregivers. The access2 is interfaced to the laboratory information systems l.
A critical value critical result is defined as a value result that represents a pathophysiological state at such variance with normal expected values as to be. Critical results in the shands jacksonville laboratory, these are referred to as panic values are test results that fall significantly outside the normal range and may represent lifethreatening values and require urgent medical intervention. Common laboratory values cheat sheet diagnostic tests are crucial in any aspect of clinical practice since they assist clinicians in establishing and determining the particular condition of the patient. The results must be read back by the authorized staff and the call documented in comm log. The concept of critical values for laboratory results was first introduced by lundberg in 1972. The 1997 american society for clinical pathology critical values practice parameter published in the journal is another outstanding resource. Test critical value s units bacillus anthracis, culture, nucleic acid positive. A critical value defined by a quantitative cut off range or a qualitative result. Mlabs will notify the client by telephone of results that are. Critical values laboratory test interpretations for. Analysis of laboratory critical value reporting at a large academic.
Additionally, after completing this module, you will be able to discuss reasons why these common lab values may be either elevated or decreased. Policy the medical director of the laboratory shall establish a list of critical. Legacy laboratory client services 503 41234 toll free 877 2705566 page 2 of 2 microbiology critical values test age critical value courtesy call value viral cultures any viral culture any positive or suspicious for h5n1 influenza, any pandemic or bioterrorism agent any viral culture on csf, blood, sterile body fluid or. We propose a number of recommendations for improvement, including that the critical values list should be approved by the medical staff, each laboratory should develop a written policy for handling initial and repeat critical values reports, a foolproof policy should be established to report results from calls abandoned, and efforts at. The content of publications of laboratory medicine best practices is in the public domain. Although most published critical value lists do not include blood bank testing. Listed below are the established critical limits for the microbiology area.