Study on the application of critical laboratory values

Abstract

Objective By analysing the historical data of critical laboratory values,the development of practicable critical values reporting system was investigated. Methods There were totally 63 794 critical values reported by the Department of Laboratory Medicine of the First Affiliated Hospital of Fujian Medical University from Nov,2008 to Oct,2012.We analysed the yearly incidence,the analytes and the distribution of critical values; we also compared the report timeliness and false rejection rate before and after the informationization and differential management of the critical values report; Meanwhile we compared the clinician response time before and after the implementation of the new out-patients critical values reporting flow. Results There were 15 000-18 000 critical values reports yearly accounting for 1.53% (63 794/4 166 267) of the total results.Most of the critical values reports were from in-patients (about 80%),and the top 3 analytes of critical values were PLT, K+ and APTT.The critical values reports were not uniformly distributed the ICU Department,Hematology Department,Emergence Department and Liver Center were concentrated distribution departments.It took 3-8 minutes (median:5 min) for staff in the Department of Laboratory Medicine to call the clinician/nurse after critical values were known and the false rejection rate was 7.53% (949/12 596).However,it just took 5-10 s to notify the clinician/nurse via the electronic alert system,and the false rejection rate was 0.There was a significant decrease of critical values reports about the in-patients in the Hematology Department and the Liver Center since the definition of critical values in these two departments was slightly modified,that was from 13.85% to 11.24% (the Hematology Department) and from 12.77% to 8.43% (the Liver Center),respectively.And since the new out-patients critical values reporting flow was adopted (different reporting flows during office hours and out of hours),the clinician response time decreased from 20 min to 7 min. Conclusions The informationization of the critical values report is helpful to improve work efficiency and the accuracy rate.And the hospital should make practicable critical values reporting system on the basis of individual institutional needs,especially the out-patient critical values reporting flow.(Chin J Lab Med,2013,36:565-568) Key words: Clinical laboratory information systems; Reference values; Reference standards; Hospital administration