The document discusses critical value notification in laboratories. It defines critical values as laboratory results that represent a life-threatening condition requiring prompt action. The article outlines the 11 steps in performing a laboratory test from ordering to taking action. It advocates laboratories ensure communication of important results between providers and appropriate follow up action.
The document discusses critical value notification in laboratories. It defines critical values as laboratory results that represent a life-threatening condition requiring prompt action. The article outlines the 11 steps in performing a laboratory test from ordering to taking action. It advocates laboratories ensure communication of important results between providers and appropriate follow up action.
The document discusses critical value notification in laboratories. It defines critical values as laboratory results that represent a life-threatening condition requiring prompt action. The article outlines the 11 steps in performing a laboratory test from ordering to taking action. It advocates laboratories ensure communication of important results between providers and appropriate follow up action.
The document discusses critical value notification in laboratories. It defines critical values as laboratory results that represent a life-threatening condition requiring prompt action. The article outlines the 11 steps in performing a laboratory test from ordering to taking action. It advocates laboratories ensure communication of important results between providers and appropriate follow up action.
Race and sex differences in hip nonsyncopal falls: a prospective study. JAMA. 1989;261:2663-2668. fracture incidence. Am J Public Health. 1984;74:1374-1380. 7. Heaney RP, Avioli LV, Chesnut CH III, Lappe J, Recker RR, Branden- 2. Resnick NM, Greenspan SL. 'Senile' osteoporosis reconsidered. JAMA. burger GH. Osteoporotic bone fragility: detection by ultrasound transmission 1989;261:1025-1029. velocity. JAMA. 1989;261:2986-2990. 3. Peck WA, Riggs BL, Bell NH, et al. Research directions in osteoporosis. Am 8. Riggs BL, Wahner HW. Bone densitometry and clinical decision-making in J Med. 1988;84:275-282. osteoporosis. Ann Intern Med. 1988;108:293-295. 4. Cummings SR, Black DM, Nevitt MC, et al. Appendicular bone density and 9. Osteoporosis. JAMA. 1984;252:799-802. Consensus Conference. age predict hip fracture in women. JAMA. 1990;263:665-668. 10. Kennie DC, Reid J, Richardson IR, et al. Effectiveness of geriatric rehabili- 5. Tinetti ME, Speechley M, Ginter SF. Risk factors for falls among elderly tative care after fractures of the proximal femur in elderly women: a randomized persons living in the community. N Engl J Med. 1988;319:1701-1707. clinical trial. Br Med J. 1988;297:1083-1086. 6. Nevitt MC, Cummings SR, Kidd S, Black D. Risk factors for recurrent
Critical (Panic) Value Notification:
An Established Laboratory Practice Policy (Parameter) A laboratory test begins when a clinician (or patient) asks a question that requires a laboratory result to answer. It ends with an appropriate action being taken on the patient's behalf Action "" based on that result. There are at least 11 steps in the perfor- Interpretation Question mance of that test (Figure). We have called that sequence the ' "brain-to-brain loop."1 A chain is known to be only as strong as its weakest link. Thus, anything that interferes with the Reporting "[est Selection complete closing of this loop for every laboratory test re- î Ordering quested produces at the least, a waste, and at the most, a Ana|ysis Identification tragedy. Preparation Collection See also p 704. Transportation Historically, most laboratory personnel have concentrated on the analytic portion of the loop. However, modern quality The 11 steps in the performance of a laboratory test. assurance requires that laboratory personnel consider all steps, actively participating in preanalytic and postanalytic components. vital laboratory values. We have defined these as laboratory The critical value reporting system is an early example of values that represent a pathophysiological state at such vari¬ this expanded approach. Nearly 20 years ago we organized ance with normal as to be life threatening and for which a such a system at the Los Angeles County/University of corrective action can be taken but for which rapid action is not Southern California Medical Center.2,3 We defined a critical as crucial. While a typical critical value would be a serum (panic) value as one that represents a pathophysiological potassium level of 2.6 mmol/L, an example of a vital laborato¬ state at such variance with normal as to be life threatening ry value would be a culture that is positive for Mycobacterium unless something is done promptly and for which some correc¬ tuberculosis or a cytological smear of the cervix that is posi¬ tive action could be taken. The system required that the tive for squamous cell carcinoma. laboratory personnel who identified the critical value verify Since failures of communication of important pieces of in¬ its accuracy and then take personal responsibility to notify an formation between people, between different segments of a appropriate individual to ensure that an appropriate action hospital, and between different health care systems are so would be taken. frequent, it may become the responsibility of the laboratory The system caught on immediately and soon was incorpo¬ person who first recognizes the vital information to make rated into requirements by the Laboratory Accreditation certain that the information is properly communicated, re¬ Program of the College of American Pathologists and the ceived, interpreted, and acted on to fulfill our responsibility to Joint Commission on Accreditation of Hospitals. the patients we serve. It is always up to the medical staff to work with pathologists to determine which tests are included in the critical value list George D. Lundberg, MD and which limits are applied to the results. As reported in this 1. Lundberg GD. Acting on significant laboratory results. JAMA. 1981; issue of The Journal, Kost,4 at the University of California, 245:1762-1763. 2. Lundberg GD. When to panic over abnormal values. Med Lab Observer. Davis, has performed a valuable service in surveying many 1972;4:47-54. hospitals from a wide geographic range to determine the 3. Lundberg GD. Managing the Patient-Focused Laboratory. Oradell, NJ: current practice of reporting of critical values. Medical Economics Books; 1975. 4. Kost GJ. Critical limits for urgent clinician notification at US medical cen- Now may be the time to expand such a system to include ters. JAMA. 1990;263:704-707.
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Belykh, E., Krutko, A. V., Baykov, E. S., Giers, M. B., Preul, M. C., & Byvaltsev, V. A. (2017). Preoperative estimation of disc herniation recurrence after microdiscectomy predictive value of a multivariate model based
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