Saturday, April 19, 2014

Critical results: use them wisely

All laboratory professionals know what is a critical value. The original definition was created by Lundberg in MLO in 1972 as: "a laboratory test result a pathophysiological State on such variance with normal represents about life-threatening unless something is done quickly and for that some corrective action can be taken". There are two pieces to this end. First of all, it is a life-threatening value. Secondly, it's a value that should be followed up immediately and during that some action can be taken.


All laboratories and health systems define their own tests those critical values, which are those critical values and those tests that are themselves ' critical '. A "critical test" should the results reported every time, regardless of the result. ' Critical ' values are life-threatening conditions on tests that routinely not life-threatening. When you create and define this list, the people involved the definition of a critical value firmly in mind and do not to include a of the analyte concentrations that are not life-threatening. Most hospital lists include sodium, potassium and glucose as a minimum on their list of tests with critical values; many hospitals contain a large number of other tests. For example, creatinine is a test that is included oftenoften, and yet, at what level of the patient's creatinine is emergently life threatened? It is sometimes difficult to please all your medical staff with what values must be regarded as critical and which should not, and those tests will have to be called back to a care-giver immediately.


Make a solution has been carve-outs-areas of the hospital that do not require a notification about certain "critical" results. For example you may not notice each time one of their dialysis patients a "critical" creatinine. Or the ICU may not to sign up for each individual critical potassium on a patient are they follow and control often during an internal shift. The problem with "carve-outs" is that if you have lots of them has set the technologist to fail. How can they keep track of what should be called and what is not?


It is important that laboratory professionals their list of critical values to define this system as streamlined as possible. If your institution has too many "critical values" defined, it may be taking too much time from the laboratory professional and the caregiver's day for a call with too many unnecessary and/or values.  You might want to watch it again and see if that definition all tests on your critical list really meet the definition of ' critical '.



-Patti Jones PhD, DABCC, FACB, is the Clinical Director of the chemistry and metabolic disease laboratories in children's Medical Center in Dallas, TX and a Professor of Pathology at the University of Texas Southwestern Medical Center in Dallas.


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