Implementation, validation and review of a critical values list in a cardiac emergency room

Torres, Diogo; Allegro, Liliana; Silva, Maria Cleide Freire Clementino da; Júnior, José Gildo Moura Monteiro; Barros, Maria das Neves Dantas da Silveira; Villachan, Lúcia Roberta Rego; Ramos, Thadzia Maria de Brito

doi:10.5935/1676-2444.20140036

Cited by 5 publications

(4 citation statements)

References 22 publications

(9 reference statements)

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“…Hospital laboratories, however, opine that the CCMB list of critical results needs reviewing and up-dating. The CCMB list of critical values has contributed greatly to the harmonization of this aspect of critical result management, but it must be emphasized that critical result lists should be tailored by each individual laboratory, in consultation with physicians/clinicians, thus implementing data from published literature with professional experience ( 5 , 17 , 20 ). Expectedly, this aspect of critical results management will hardly ever achieve complete national harmonization.…”

Section: Discussionmentioning

confidence: 99%

Croatian survey on critical results reporting

et al. 2015

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IntroductionPoor harmonization of critical results management is present in various laboratories and countries, including Croatia. We aimed to investigate procedures used in critical results reporting in Croatian medical biochemistry laboratories (MBLs).Materials and methodsAn anonymous questionnaire, consisting of 24 questions/statements, related to critical results reporting procedures, was send to managers of MBLs in Croatia. Participants were asked to declare the frequency of performing procedures and degree of agreement with statements about critical values reporting using a Likert scale. Total score and mean scores for corresponding separate statements divided according to health care setting were calculated and compared.ResultsResponses from 111 Croatian laboratories (48%) were analyzed. General practice laboratories (GPLs) more often re-analyzed the sample before reporting the critical result in comparison with the hospital laboratories (HLs) (score: 4.86 (4.75-4.96) vs. 4.49 (4.25-4.72); P = 0.001) and more often reported the critical value exclusively to the responsible physician compared to HLs (4.46 (4.29-4.64) vs. 3.76 (3.48-4.03), P < 0.001). High total score (4.69 (4.56-4.82)) was observed for selection of the critical results list issued by the Croatian Chamber of Medical Biochemistry (CCMB) indicating a high harmonization level for this aspect of critical result management. Low total scores were observed for the statements regarding data recording and documentation of critical result notification.ConclusionsDifferences in practices about critical results reporting between HLs and GPLs were found. The homogeneity of least favorable responses detected for data recording and documentation of critical results notification reflects the lack of specific national recommendations.

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Section: Discussionmentioning

confidence: 99%

Croatian survey on critical results reporting

et al. 2015

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“…Their critical risk result is based on agreement with hospital cardiologists, rheumatologists, endocrinologists and haematologists. On the other hand, in a Brazilian survey by Torres et al lower critical risk result for platelets was set at < 20 x10 9 /L through a consensus of the cardiac emergency department and cardiac intensive care unit physicians ( 14 ). This value corresponds to the one on the CCMB’s list.…”

Section: Discussionmentioning

confidence: 99%

“…Interestingly, they reported different responses for revision of this parameter between intensivists and general paediatricians, with intensivists proposing more extreme critical risk results. Paediatric population is also included in a Brazilian survey of Torres et al ( 14 ). In comparison with ours, their list includes more parameters.…”

Section: Discussionmentioning

confidence: 99%

“…The same situation is reported in Italy in survey by Lippi et al , showing that critical risk results are mainly notified to physicians ( 10 ). There are surveys that confirmed positive effects of prompt critical risk result notification which led to change in patient’s treatment ( 5 , 14 , 20 ). By tailoring list of critical risk results in agreement with physicians, better patient care is provided, less unnecessary alerts are made, and laboratory has better post-analytical management.…”

Section: Discussionmentioning

confidence: 99%

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Clinician’s opinion about critical risk results proposed by the Croatian Chamber of Medical Biochemists

Šonjić

Nikler²,

Vuljanić³

et al. 2019

Biochem. med. (Online)

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Introduction: It has been recommended that each laboratory modify their critical result reporting practices to reflect the clinical needs of their patient populations. The aim of this survey was to assess how well critical laboratory values defined by the Croatian Chamber of Medical Biochemists (CCMB) correspond to the needs of the physicians at University hospital “Sveti Duh” (Zagreb, Croatia). Materials and methods: We conducted a survey among physicians from five departments in our hospital. Physicians were asked general questions about critical risk results (if and how they want to be informed). A list of critical risk results defined by the CCMB was offered and physicians were asked to revise the existing critical risk results and suggest adding new parameters. Obtained data were presented as numbers. Where the number of observations was low, ratios were used. Results: Survey response rate was 43% (52/121). Majority (48/52) wants to be informed of critical risk results, either personally (31/48) or through a colleague (32/48). They prefer to be informed about critical risk results of prothrombin time, platelet count, haemoglobin, glucose, creatinine, sodium and potassium. Revisions in the CCMB critical risk result list are proposed by 13 out of 48 physicians. Neonatologists approved the CCMB’s list. Conclusions: Although most critical risk results defined by the CCMB correspond well to the needs of the physicians in our hospital, some revisions are necessary to meet the particular needs of individual departments. Communication of critical risk results to those who have requested laboratory testing is highly appreciated practice.

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Evidence-based cutoffs for total and adjusted calcium: a major factor in detecting severe hypo- and hypercalcemia

Schmidt,

Steinbach,

Federbusch

et al. 2023

Clinical Chemistry and Laboratory Medicine (CCLM)

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Objectives Severe hypo- and hypercalcemia are common and urgent treatment is recommended. Free calcium (fCa) is the gold standard but needs blood gas tests with challenging preanalytics. Total calcium (tCa) and calculated adjusted calcium (aCa) are readily available, but their interpretation is hampered by identical tCa and aCa cutoffs, laborious local aCa calculation and difficult comparability of calcium biomarkers. Methods Laboratory results from University Medicine Leipzig were evaluated over a five-year period (236,274 patients). A local aCa equation was derived by linear least squares regression, the agreement between fCa, tCa and aCa assessed with Cohen’s κ and decision thresholds derived by this indirect method. Results The local aCa equation was created from data of 9,756 patients, each with one paired measurement of tCa, fCa and albumin. Derived aCa cutoffs (1.95/3.15 mmol/L) differ markedly from derived tCa cutoffs (1.6/2.9 mmol/L) and severe hypo- and hypercalcemia can be more accurately assessed by aCa (κ=0.489, 0.812) than by tCa (κ=0.445, 0.744). Comparing our approach to standard care (tCa, literature cutoff), a total 3,250 of 3,680 (88.3 %) misclassified measurements were correctly classified when using aCa with evidence-based cutoffs. Conclusions Optimized cutoffs for aCa and tCa hold great potential for improved patient care. Locally derived aCa equations differ mostly in the chosen mean normal calcium and provide minimal overall improvement, but entail a close examination of the used cutoffs before application.

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Implementation, validation and review of a critical values list in a cardiac emergency room

Cited by 5 publications

References 22 publications

Croatian survey on critical results reporting

Croatian survey on critical results reporting

Clinician’s opinion about critical risk results proposed by the Croatian Chamber of Medical Biochemists

Evidence-based cutoffs for total and adjusted calcium: a major factor in detecting severe hypo- and hypercalcemia

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