Critical value notification in clinical laboratories

Objective and Hypothesis: Clinical laboratories have important roles in the diagnosis, monitoring and treatment of the diseases. Test results affect human health directly, and the use of results for the benefit of the patient is important in terms of the patient's safety. So the accuracy and the timeliness of the results are also extremely important from the standpoint of quality standards. Critical values, formerly stated as panic values, are defined as results suggesting that the patient is in imminent danger unless appropriate therapy is initiated promptly. Therefore their notification to the responsible clinician for the patient therapy is important in terms of patient care and safety. The aim of this study is to determine the number, characteristics and distribution of the test results with critical values and their notification in Dokuz Eylül University Central Laboratory and to make some suggestions to improve the reporting process. Method: The emrgency and routine biochemical test results of blood gas, complete blood count (CBC), erythrocyte sedimentation rate (ESR), coagulation and urine analyses with the critical values are obtained from DEU Central Laboratory from January 2013 to December 2013. The data is categorized and evaluated according to; -Time from completion of the analysis to notification -Time from result validation to notification -Person making the notification -Person receiving the notification -Distribution in test groups -Distribution in clinical wards All results are stated as total number and percentage (%). Results: Total number of tests in different test groups in section of clinical chemistry from January 2013 to December 2013 is listed below: -4.837.920 in routine chemistry group -435.618 in blood gas group -5.715.088 in CBC-ESR group -222.965 for coagulation group -777.050 urine analysis group Total number of tests with a critical value is 28.974. The average critic value number that should be reported in 1 day is 79. Of the results with critical values; 74% belong to inpatients, 7% to the outpatients and 20% to the emergency patients. As the 42% of the results with critical values are the values which are repeated for the same patient, the notification of these results is not necessary. 18% of them are the values which were reported to the related clinician and 36% are the ones which couldn't have been reported to anyone. 77% of the notifications were done in 30 minutes after the confirmation of results 90% of them have been done by laboratory specialists or assistant and 94 % have been reported to the related doctor. Conclusion/Discussion: The test results with a critical value pose an important healthcare problem for the patient and needs an urgent intervention of the treatment program. Determination of the critical value test list and critical value limits with the consensus of both the clinicians and laboratory physicians helps the process function effectively. To reduce the workload and time spend to notify and to receive the results in the wards and in the laboratory, specific critical value test lists, limits and specific time intervals for notification of the results can be established for different clinics. Educational meetings, more frequently especially in the beginning may help to enhance the implementation of the notification process. KEYWORDS: Critical values, clinical laboratory, quality, accreditation, patient safety