Laboratory Critical Value Research Articles

Analysis of Factors That Cause the Target of Laboratory Critical Value Report Has Not Been Reached: Study at the Clinical Pathology Department at Haji General Hospital Surabaya

Background: A laboratory critical value is a laboratory test result represents a pathophysiologic state at such variance with normal which threaten patient’s life if a medical action is not taken immediately and for which an effective action is possible. The reporting of laboratory critical value at the Clinical Pathology Department at Haji General Hospital Surabaya for the January-July 2020 period had not reached 100%. Objectives: This study analyzed the factors cause the target of laboratory critical value report has not been reached at the Clinical Pathology Department at Haji General Hospital Surabaya based on psychological and organizational factors. Methods: This study was a descriptive observational study with cross-sectional approach. The samples were 23 people in total sampling. The data were collected by questionnaire that had been tested for validity and reliability. Results: The results showed that 73.9% of respondents had high motivation, 91.3% of respondents had good perceptions, 82.6% of respondents had type B personality, 69.6% of respondents had good learning, 78.3% respondents had low work stress, 52.2% of respondents stated that leadership was quite good, 95.7% of respondents said moderate rewards, 60.9% of respondents stated that the work design was according to the profession, 87.0% of the organizational structure was effective. Conclusion: Factors that caused target of laboratory critical value report has not been reached at the Clinical Pathology Department at Haji General Hospital Surabaya for the January-July 2020 period, based on the 80/20 Pareto Principle are motivation, learning, leadership, and job design. Health analysts should increase self-motivation, make experiences as learning, leaders as co-workers, work well willingly and the Clinical Pathology Department to reward the best employees, conduct evaluations, provide understanding and explanation in decision making, regulate the rotation of the division of tasks.

A study of critical value analysis at hematology and biochemistry sections of laboratory in a multispeciality hospital

The issue of laboratory critical value (CV) reporting has gained importance in the recent times due to the national focus on patient safety. Critical value notification (CVN) has become an essential part of accreditation procedures for medical laboratories, including the universally accepted International Organization for Standardization (ISO) 15189: 2012. Our study aimedto analyze the critical value data in hematology and biochemistry sections of the laboratory, to compare the frequencies of critical values for different parameters and to suggest measures for improving the effectiveness and operational efficiency of the critical value notification process.Our study was a retrospective, cross-sectional, descriptive study done over a period of one year six months (January 2020 to June 2021). The parameters chosen for CVN included platelets, hemoglobin and International Normalized Ratio (INR) from hematology section and creatinine, glucose, sodium, potassium and calcium from the biochemistry section. A test result that was significantly outside the normal range and that required immediate communication was considered as a “critical value (CV)”. Both verbal (through telephone) and non-verbal [through short message service (SMS)] communication processes for CVN were implemented in our lab. We also followed the practice of CV “read-back” by the person who was informed over the phone. A total of 2199 critical values were reported. A maximum of 1224 (55.7%) critical values were recorded from the emergency department. CVs were highest from biochemistry (1898, 86.3%) section. Analyte most commonly notified was creatinine (1151, 52.3%). CVNs were maximum in the morning shifts (1378, 62.7%).Implementation of the critical alert short message service (SMS) send outs has greatly helped us in reducing the CV turn around time (TAT). Our study has successfully demonstrated the importance of both verbal and non-verbal communication processes for notification of CVs.

The importance of hospital re-accreditation: improving the timeliness of laboratory critical value reporting

Background: Patient safety is the main issue in healthcare services nowadays. Delaying to inform the critical value of laboratory results is a significant source of harm for the patient. The aim of this study is to compare the timeliness of laboratory critical value reporting before and after re-accreditation as one of the service quality indicators in Hospital X.
 Methods: This study was done by using observational cross-sectional in Hospital X on January - February 2020 with total sampling method of critical value reporting to the responsible clinician that originated from Intensive Care Unit (ICU), Verlos Kamer (VK), and inpatient ward (IW) 1-6 from January-December 2019. The timeliness of reporting was counted since the laboratory result was obtained until received by the responsible clinician within £ 30 minutes and categorized as "On time" or "Late".
 Results: During 2019, there were 816 reporting which has been done before re-accreditation (511) and after re-accreditation (305) with 17 kinds of tests. The most reported test was platelet with 349 (before re-accreditation) and 101 (after re-accreditation), whilst SGOT/SGPT and albumin were the fewest one. The lowest timeliness of reporting percentage was 76,00% (February), whilst the highest was 98,48% (November). The timeliness of reporting's percentage was 84,34% (before re-accreditation) and 94,43% (after re-accreditation). The statistical analysis result revealed Pearson Chi-Square correlation was 18,535 with significance 0,000 and 3,145 odds ratio which shows that re-accreditation could significantly increase the timeliness of critical value reporting three times.
 Conclusion: This result showed that re-accreditation could affect the timeliness of laboratory critical value reporting to the responsible clinicians.
 Keywords: re-accreditation, critical value, laboratory, patient safety, hospital
 
 Abstrak
 Latar belakang: Keselamatan pasien merupakan isu utama dalam pelayanan kesehatan. Tertundanya komunikasi hasil nilai kritis laboratorium merupakan sumber bahaya yang signifikan terhadap pasien. Penelitian ini bertujuan untuk membandingkan ketepatan waktu pelaporan nilai kritis laboratorium sebelum dan setelah reakreditasi sebagai salah satu indikator mutu di RS X.
 Metode: Penelitian dilakukan dengan cara observasional dengan metode cross sectional di RS X pada Januari - Februari 2020 dengan total sampling laporan nilai kritis kepada Dokter Penanggung Jawab Pasien (DPJP) yang berasal dari ruang Intensive Care Unit (ICU), Verlos Kamer (VK), dan ruang rawat inap 1 – 6 sejak Januari – Desember 2019. Ketepatan waktu pelaporan dihitung sejak hasil pemeriksaan didapatkan hingga diterima oleh DPJP dalam waktu £ 30 menit dan dinyatakan sebagai "Tepat Waktu" atau "Terlambat".
 Hasil: Selama tahun 2019, terdapat 816 pelaporan yang dilakukan sebelum akreditasi (511) dan setelahnya (305) dengan 17 jenis pemeriksaan. Pemeriksaan trombosit menjadi yang paling banyak dilaporkan yaitu 349 (sebelum akreditasi) dan 101 (setelah akreditasi), sedangkan SGOT/SGPT dan albumin menjadi yang paling sedikit. Persentase ketepatan waktu pelaporan paling rendah adalah 76,00% (Februari) sedangkan yang paling tinggi adalah 98,48% (November). Persentase ketepatan waktu pelaporan didapatkan 84,34% (sebelum akreditasi) dan 94,43% (setelah akreditasi). Hasil analisis statistik didapatkan korelasi Pearson Chi-Square 18,535 dengan signifikansi 0,000 dan Odds ratio 3,145 menunjukkan re-akreditasi mampu meningkatkan kemungkinan ketepatan waktu pelaporan nilai kritis sebesar tiga kali lipat.
 Kesimpulan: Hal ini menunjukkan bahwa re-akreditasi mampu mempengaruhi ketepatan waktu pelaporan nilai laboratorium kritis kepada DPJP.
 Kata kunci: re-akreditasi, nilai kritis, laboratorium, keselamatan pasien, rumah sakit.

Critical values in cytology

The timely reporting of critical values, or values that may be life-threatening if immediate action is not taken, is essential to patient care and safety. Although some guidelines exist for critical diagnoses in cytology, not all laboratories have a specific list of diagnoses that should be considered critical, and the very existence of cytology "critical values" has been called into question. Here we propose a pragmatic system for determining cytology critical values and report our laboratory's critical value list, formulated based on a review of the medical literature regarding clinical urgency and other institutions' cytology critical value lists.

Analysis of the Diffrence of Completeness of Reporting and Documentation of Laboratory Critical Values Pre and Post-Intervention in Bona Ward Dr. Soetomo Hospital Surabaya

Completeness of laboratory critical values reporting and documentation in medical records is important for patient safety, hospital accreditation, and legality. Preliminary study in Dr. Soetomo Hospital's ward showed the laboratory critical value report and documentation was 0% complete, 4% incomplete, and 96% undocumented. This was a quasi experimental study with one group pretest and posttest design. Technical guidance of laboratory critical values reporting and documentation in medical records and supervision were given to 26 doctors. The results evaluated were doctor knowledge and attitude towards critical value reporting, completeness of documentation in medical records, and turn around time (TAT). Reporting critical values samples number was 72 before and after the intervention. The critical values samples taken by purposive sampling. The data was analyzed using Mann-Whitney test. There were significant differences in the level of knowledge, doctor's attitudes, and completeness of critical values documentation before and after the intervention. Doctors with good knowledge increased from 3.85% to 92.31%. The attitude to complete critical values documentation improved from 0% to 76%. Completeness of critical values documentation in medical records improved from 100% undocumented to 19.44% undocumented, 11.11% incomplete, and 69.45% complete. There were no significant differences of TAT before and after the intervention, all of TAT were less than 30 minutes and meeting the TAT category. The intervention succeeded in increasing doctor knowledge, attitude, and completeness of the laboratory critical values reporting and documentation in the patient's medical record. Keywords: Laboratory critical value, medical record, turn around time.

Enhance the effectiveness of clinical laboratory critical values initiative notification by implementing a closed-loop system: A five-year retrospective observational study.

BackgroundAccurate and timely clinical laboratory critical values notification are crucial steps in supporting effective clinical decision making, thereby improving patient safety.MethodsA closed‐loop laboratory critical value notification system was developed by a multidisciplinary team of clinicians, laboratorians, administrators, and information technology experts. All the laboratory critical values that occurred at Beijing Tsinghua Changgung Hospital (BTCH, Beijing, China) from 2015 to 2019 were analyzed and studied retrospectively.ResultsThe total number (ratio) of institutional laboratory critical values to all reported items at BTCH from 2015 to 2019 was 38 020/7 706 962 (0.49%). Percentage distribution points of critical value boundaries based on patients’ test reports are 0.007% ~ 6.04% for low boundaries and 71.70% ~ 99.99% for high boundaries. After the intervention, the timely notification ratio, notification receipt ratio, and timely notification receipt ratio of critical values of ED, IPD, and total patients had increased, with a significant difference (P < .001). Five quality indicators, such as notification ratio, timely notification ratio, notification receipt ratio, timely notification receipt ratio, and clinician response ratio over a 5‐year period, were 100%, 94%, 97%, 92%, and 99%, respectively.ConclusionsWe enhanced the effectiveness of clinical laboratory critical values initiative notification by implementing a closed‐loop system and intervening. Clinical critical values and quality indicators should be analyzed and monitored to avoid adversely affecting patient care.

Study on laboratory critical value analysis in a multi-speciality hospital

Study on laboratory critical value analysis in a multi-speciality hospital

Analysis of laboratory critical value reporting in the department of spine surgery and management strategies

Objective To investigate the common critical value (CV) of patients hospitalized in the department of spine surgery and to determine the corresponding management. Methods Medical records of patients between 2013 January and 2014 December were retrospectively reviewed. 47 cases with CV were noted. The following characteristics of CV were recorded and analyzed, including time-point at occurrence, type, reason and management. Results Most of the CVs (43/47, 91.5%) were detected between 8 am to 12 am, and between 17 pm and 21 pm. Overall, there were 24 cases of abnormal blood electrolyte (51.1%), 13 cases of abnormal routine blood test (27.7%), 5 cases of abnormal blood coagulation test (10.6%), and 1 case of abnormal TnT (2.1%). The remaining 4 cases including 2 cases detected in the night (1 case of abnormal blood gas test and 1 case of abnormal TnT) and 2 cases detected in the afternoon (1 case of positive blood bacteria culture and 1 case of low blood glucose level). Conclusions The most common CVs were summarized in the clinical practice. The findings have important clinical implications concerning the management of these CVs. In addition, preventive modality of daily nursing and standardization of medical management should be applied so as to ensure the safety of patients and rapid recovery. Key words: Critical value; Management strategies; Spine surgery

Analysis of Laboratory Critical value Reporting Pattern at clinical biochemistry laboratory of Tertiary health care Center

Objectives: Objective of the study is to analyze critical value reporting data to find frequency of critical reporting, distribution of critical values across reportable range and across hospital segments and reasons for failure in critical reporting. Material & Method: The critical value reporting data for various analysts were collected from LIS for 1 year. The data were analyzed in computer spreadsheets. Result & Discussion: Of 548786 test results analyzed, about 10% results were critical. Total Billirubin (20.14 %), Indirect Billirubin (18 %), Glucose (18%) and Sodium (13.6 %),Potassium (11.8%) contributed most to the critical values. 29% of urea, 13.29 % of Glucose ,15.37% of Indirect Billirubin, 13.71% of Sodium, 13.29% of Glucose & 11.6 % of total analyzed potassium were critical. On a per test basis, inpatient tests were 3.6 times more likely to result in a critical callback than outpatient tests. The number of critical values per year per bed was 176.34 for ICU beds and 29.36 for non-ICU beds and 5.0 for Emergency Department. Conclusion: The high proportion of reported critical value of urea is due to practice of reflex testing in the laboratory whenever Creatinine is in abnormal range. The high proportion of reported critical value of Indirect Billirubin is due to present of PICU, NICU in Hospital. Major reasons for failure of notification of critical alert are incomplete detail on request form, transfer of patient to Ward or ICU, phone is engaged or phone not picked up by care giver.

Establishing an evidence base for critical laboratory value thresholds.

Critical values denote laboratory test results indicating a life-threatening situation. The outcomes of this premise have not been rigorously evaluated. Five years of inpatient admissions were examined for critical or "near-critical" results (total admissions = 165,066; total test results = 872,503). In-hospital mortality was examined as a function of time and degree of test result abnormality. Some critical value thresholds appropriately identified patients at risk for death (eg, elevated potassium). Other thresholds were too conservative (elevated hematocrit, hemoglobin) or not conservative enough (elevated lactate). Mortality risk for most critical values was time dependent, but some critical values showed no temporal effect on mortality (elevated activated partial thromboplastin time [APTT], international normalized ratio [INR], and glucose). Following an initial critical result, further worsening was associated with increased mortality. Prior hospital admission within 30 days was a predictor of lower mortality for some (elevated APTT, INR, potassium, and sodium; low glucose, hematocrit, hemoglobin, and potassium) but not other critical values (elevated lactate, glucose, hematocrit, and hemoglobin; low sodium). Only a subset of laboratory critical value thresholds was optimally chosen for increased risk of in-hospital mortality, with a time urgency for most but not all critical values. For many tests, a prior hospital admission imparted a decreased risk of in-hospital death.

Laboratory critical values: Automated notification supports effective clinical decision making

ObjectiveFailure to adequately communicate a laboratory critical value (CV) is a potential cause of adverse events. The harmonization of CV reporting is increasingly recognized as a key issue in ensuring patient care and minimizing harm. With ongoing improvements in CV reporting, the patient's outcome should be audited to assess the effectiveness of CV notification. Design and methodsWe report the data audited throughout a six month-period during which an analysis was made of CVs, and we describe the approach of clinicians and general practitioners (GPs), and their decision making following CV reporting. ResultsCV notification led to a change of treatment in 98.0% of patients admitted to surgical and in 90.6% of those admitted to medical wards. Clinicians made a further evaluation of new complications in patients in 70.0% and 60.4% of cases, in surgical and medical wards respectively. In more than 40.0% of cases, CVs were unexpected findings. In the primary care setting, critical hyperkalemia was managed by GPs in 55% of patients, thus sparing patient's hospitalization. For all outpatients with critical INR (international normalized ratio), the GPs changed or stopped warfarin dosage. Twenty-four percent of patients were checked for an additional INR, whereas a further medical examination by a consultant in the hospital setting was requested for 5% of patients. ConclusionsThe laboratory plays a key role in ensuring patient safety, especially in CV reporting. An evaluation should be made of the patient's outcome and clinical decision making in order to assess the effectiveness of the CV process.

Critical value reporting: A survey of 36 clinical laboratories in South Africa

Critical value policies are used by clinical laboratories to decide when to notify caregivers of life-threatening results. Despite their widespread use, critical value policies have not been published locally. A survey was designed to determine critical value policies for haematology tests in South Africa. A survey was carried out on 136 identified laboratories across South Africa in January 2013. Of these, 36 responded. Data collected included critical value policies, critical values for haematology parameters, and critical value reporting. Of the 36 laboratories surveyed, 11.1% (n=4) were private, 33.3% (n=12) were affiliated to academic institutions and 55.6% (n=20) were peripheral or regional National Health Laboratory Service laboratories. All the laboratories confirmed that they had a critical value policy, and 83.3% of such policies were derived from local clinical opinion. Mean low and high critical limits for the most frequently listed tests were as follows: haemoglobin <6 and >20 g/dl, platelet count <41 and >1 000 ×10(9)/l, white cell count <2 and >46 ×10(9)/l, activated partial thromboplastin time >101 seconds, and international normalised ratio >6. In almost all cases critical value reporting was performed by the technologist on duty (97.2%). The majority of laboratories required that the person notified of the critical value be the doctor who ordered the test or the caregiver directly involved in the patient's care (83.3%); 73.3% of laboratories indicated that they followed an algorithm if the doctor/caregiver could not be reached. Each laboratory is responsible for establishing clinically relevant critical limits. Clinicians should be involved in developing the laboratory's critical value policy. The findings of this survey may be of value to local laboratories that are in the process of establishing or reviewing critical value policies.

Analysis of Laboratory Repeat Critical Values at a Large Tertiary Teaching Hospital in China

ContextAs a patient safety measure, laboratories are required to have a critical values policy by regulatory agencies. Unfortunately, little information is available on repeat critical values for the same analyte(s) on the same patient.ObjectiveTo investigate the occurrence and distribution of repeat critical values and the relationship between the frequency of such values and patient outcome to provide information for hospitals on improving reporting policies.MethodsEleven laboratory critical value lists, including chemistry and hematology analytes, were selected from a tertiary hospital in China in the year 2010. The distribution and interval time for each repeat critical value were calculated. Serum potassium and platelet count were used as examples to illustrate the relationship between the frequency of the repeat critical values and patient outcome.ResultsAll test items on the critical value list were prone to the occurrence of repeat critical values. On average, each patient who experienced critical values had 2.10 occurrences. The median interval time for each repeat critical value varied, with most being longer than 8 hours. For those patients who had repeat critical values of serum potassium and platelet count, along with the increased frequency, the patients had a longer hospital stay and a generally worse outcome.ConclusionsPatient can have a number of repeat critical values and the frequency of these values is closely related to patient outcome. A careful evaluation is warranted if a laboratory chooses to adopt a policy of not reporting each repeat critical value.

Should we customise critical value procedure according to patient origin and laboratory turnaround time?

IntroductionOur routine laboratory critical value notification procedure is based on a short list of six fundamental critical values. The report system for our Stat laboratory is not based on this...

Laboratory critical value reporting system at pediatric clinics

Objective To evaluate the influence of laboratory critical value reporting on the efficacy of pediatric critical care.Methods A comparative analysis was conducted to evaluate the changes after the establishment of laboratory critical value reporting system.The parameters chosen for assessment included laboratory test turnaround time,medical intervention start time,survival rate,etc.Results Before the establishment of laboratory critical value reporting system,laboratory test turnaround time was (44.5±14.6)min,medical intervention start time was (40.7±5.3)min,and the success rate of the emergency treatment in ICU was (80.36±6.32)%[the rate in normal ward was(82.64±9.21)%].But after the establishment of laboratory critical value reporting system,laboratory test turnaround time,medical intervention start time,the success rate of the emergency treatment in ICU (normal ward) were (18.7±8.8)min,(23.9±6.7)min and (89.49±4.58)% [(90.04±6.45)%].Laboratory critical value reporting system shortened laboratory test turnaround time and medical intervention start time (P<0.05),and the successful rate of the emergency treatment improved evidently.Conclusion Laboratory critical value reporting system can improve successful rate of the emergency treatment significantly. Key words: Laboratory critical value reporting; Pediatrics

Analysis of Laboratory Critical Value Reporting at a Large Academic Medical Center

Reporting of laboratory critical values has become an issue of national attention as illustrated by recent guidelines described in the National Patient Safety Goals of the Joint Commission on Accreditation of Healthcare Organizations. Herein, we report the results of an analysis of 37,503 consecutive laboratory critical values at our institution, a large urban academic medical center. We evaluated critical value reporting by test, laboratory specialty, patient type, clinical care area, time of day, and critical value limits. Factors leading to delays in critical value reporting are identified, and we describe approaches to improving this important operational and patient safety issue.

Analysis of Laboratory Critical Value Reporting at a Large Academic Medical Center

Analysis of Laboratory Critical Value Reporting at a Large Academic Medical Center