Critical Value Reporting.fm

Policy

For proper patient care, the laboratory must ensure prompt

notification of the appropriate health-care provider of results of

laboratory tests which are deemed to be critical to the patient’s

health-care.

Procedure:

• Definition: A critical result is one that is outside of the

reference range and could have a significant immediate

impact on the care of the patient.

• How results are to be reported (default method)

—For all critical values, the laboratory personnel

should request and receive a read-back of the

reported values. The critical result must be

called to a licensed health-care provider.

—Inpatients—Report to the nurse caring for the

patient. In his/her absence, the following

individuals should be contacted, in this order, until

the result has been submitted; charge nurse, nurse

manager, ordering physician, attending physician.

If there are problems identifying the correct

physician, the pathologist on call should be notified

for resolution. The caller must document the date/

time of the call, and the person receiving and

reading back the information, in a comment in the

Cerner computer system. Critical values are called

within 15 minutes of test completion.

—Outpatients—Report to the nurse caring for the

patient. In his/her absence, the result should be

given to the ordering physician or physician on call

for the service. If neither is contacted, the

pathologist on call should be notified. Document,

in a comment in the Cerner computer system, the

date/time of call, person receiving and reading

back the results, and the person calling the results.

Critical values are called within 30 minutes of test

completion.

• Blood Bank

: Blood Bank personnel will call all positive

Kleihauer-Betke, direct antiglobulin tests, and direct

Coombs as directed in the section above for inpatients

and outpatients.

• Microbiology

: Microbiology will call to the fast track

station for all discharged Emergency Room (ER)

patients all positive results appearing on the critical

results list as directed in the section above for inpatients

and outpatients.

•

Hematology and Chemistry:

—Inpatients—Hematology and chemistry (all shifts)

will call inpatient critical values.

—Outpatients—On day shift, hematology and

chemistry staff will call front office when they

have a critical value. After the call, a copy of the

result should automatically print out on front office

printer with a header of “Critical Result.” If

nothing prints out, front office staff is responsible

to contact appropriate department for patient’s

name and critical information. Front office will call

physician’s office. When front office is not staffed,

hematology and chemistry staff will call critical

values.

• Home Care

: Call results to the physician of record. If

physician of record is not available, call Home Care

Office for assistance. Pathologist on call should be

notified if unable to locate physician of record.

• Procedure for Calls to Physician’s Office

—Critical result should be given directly to physician

of record.

—If physician of record is unavailable, result may be

given to another health-care provider, preferably a

nurse

—If person receiving result does not acknowledge

that it is his/her patient, the individual making the

call must go back to the prescription to confirm the

physician who ordered test.

—If there are problems identifying correct physician,

the office coordinator, laboratory manager, and/or

pathologist should be notified for resolution.

—If physician’s call service is on, leave a message

for the physician to return the call. If there is no

call within 30 minutes, call again. If after second

call there is no response back within 15 minutes,

call pathologist on call. When physician calls back,

give information and document. If physician

indicates that it is not his patient, review original

order or prescription. If it is confirmed to be his

patient, call him again, and advise him of the

confirmation. If it is found to be the patient of

another physician, call that physician with result.

Refer all of the paperwork to outreach coordinator

and/or laboratory manager.

Critical Value Reporting