Necessity of Routine Repeat Testing of Critical Values in Various Working Shifts.

Hiva Saffar,Alireza Abdollahi,Atefe Sadat Hosseini,Pegah Mohaghegh,Ghazal Hajinasrollah,Mojgan Torabi Farsani

doi:10.30699/ijp.2020.99403.1980

Abstract

Background & Objective:Accurate and timely reporting of critical values is an important issue. There is some doubt whether repeat testing of critical values would offer any advantage over single testing or not. The aim of this study was evaluation of utility of routine repeat testing of critical values in our referral center and to compare probable variations in different working shifts.Methods:Clinical results of serum Potassium, Calcium, Blood Hemoglobin and Prothrombin Time (INR: International Normalized Ratio) were evaluated for three months.Results:Totally, 178, 96, 67 and 107 consecutive critical values for Potassium, Calcium, Hemoglobin and INR were reported, respectively. In potassium and Hemoglobin 5.05% and 1.17% of retest runs exceeded the accep1 tolerance limit. All of the calcium retest results were within the acceptable limit. For INR, 21/107 retest results did not meet the acceptable tolerance limit, nine still were critical. Afternoon working run performance was significantly better than the two others.Conclusion:Our observation suggests that routine repeat of hematology and chemistry critical test result is not necessary and may adversely affect patient safety measure. However, attention should be paid to results greater than analytical measurement range and all such results should be repeated before reporting.

Highlights

The concept of “Critical Value” was first introduced by Lundberg in 1972 and since critical value reporting has been required by different regulations and accreditation programs [1,2,3].The Joint Commission International, ISO 15189 and College of American Pathologists have published well defined requirements on the identification, handling and documentation of laboratory critical values [4,5,6,7]
All of the calcium retest results were within the acceptable limit
Our observation suggests that routine repeat of hematology and chemistry critical test result is not necessary and may adversely affect patient safety measure

Summary

Introduction

The concept of “Critical Value” was first introduced by Lundberg in 1972 and since critical value reporting has been required by different regulations and accreditation programs [1,2,3].The Joint Commission International, ISO 15189 and College of American Pathologists have published well defined requirements on the identification, handling and documentation of laboratory critical values [4,5,6,7]. All laboratories should develop the list of their critical test values and a documented system for timely reporting of results to responsible health care provider [3]. There is no regulatory requirement to verify test result by repeating critical value testing [3]. Repeat critical values to ensure accuracy and avoiding false positive result is a common practice [3,8]. It appears that the repeat test practices date back to years ago when less sophisticated automatic systems have been used in laboratories [9]. The aim of this study was evaluation of utility of routine repeat testing of critical values in our referral center and to compare probable variations in different working shifts

Objectives

Methods

Results

Discussion

Conclusion