Decision Support Alerts for Clinical Laboratory and Blood Gas Data

Abstract

The process by which clinicians recognize potentially dangerous laboratory data is difficult to computerize. Normal value limits are useful reference points, but although a significant percentage of ICU laboratory results are abnormal, most should generate no undue alarm. Critical value limits such as K+<3.0 mmol/L or hemoglobin <7.0 g/dl are more relevant to critical care areas and are relatively easy to program into a data management computer system. However, simple limits are inadequate for more complex laboratory results, which must be correlated with other data to insure that true critical values are present. For example, hypocalcemia is a relatively common finding in surgical ICU patients in whom bowel disorders, abdominal surgery, stress, and sepsis may rapidly produce a hypoalbuminemic state. Because calcium is bound to albumin, in such a setting the hypocalcemia may be more apparent than real. Critical value limits will also fail to identify subtle but dangerous trends such as falling hemoglobin or hematocrit until the blood loss is quite severe and a critical value threshold is exceeded.KeywordsCreatinine KinaseAlert MessageAlert ParameterAbnormal Laboratory ResultCritical Care AreaThese keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.