The critical value concept in clinical laboratory

Scan to discover online Background & Objective: Accurate and timely reporting of critical values is an important issue. There is some doubt whether repeat testing of critical values would offer any advantage over single testing or not. The aim of this study was evaluation of utility of routine repeat testing of critical values in our referral center and to compare probable variations in different working shifts. Methods: Clinical results of serum Potassium, Calcium, Blood Hemoglobin and Prothrombin Time (INR: International Normalized Ratio) were evaluated for three months. Results: Totally, 178, 96, 67 and 107 consecutive critical values for Potassium, Calcium, Hemoglobin and INR were reported, respectively. In potassium and Hemoglobin 5.05% and 1.17% of retest runs exceeded the acceptable tolerance limit. All of the calcium retest results were within the acceptable limit. For INR, 21/107 retest results did not meet the acceptable tolerance limit, nine still were critical. Afternoon working run performance was significantly better than the two others. Conclusion: Our observation suggests that routine repeat of hematology and chemistry critical test result is not necessary and may adversely affect patient safety measure. However, attention should be paid to results greater than analytical measurement range and all such results should be repeated before reporting.

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“…There are some other studies discussing the utility of repeat testing of critical values (2,3,8,10,12,(19)(20)(21)(22)(23).…”

Section: Discussionmentioning

confidence: 99%

Necessity of Routine Repeat Testing of Critical Values in Various Working Shifts

et al. 2020

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“…Then, it is necessary to write clearly whether the results have been repeated or not repeated. Furthermore, the critical value is reported to the doctor who is responsible for taking care of the patient by telephone or other media [5].…”

Section: Discussionmentioning

confidence: 99%

Performance of Laboratory Critical Value on Clinical Laboratory Services in Supporting Patient Safety

Rosita¹,

Edy.²

2021

Advances in Health Sciences Research

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Background. Patient safety is a cornerstone of healthcare quality, including clinical laboratory services. Management of patients related to the patient safety includes all aspect of services, which covers the process of diagnosing, giving therapy, and predicting the prognosis. An important form of clinical laboratory service concerned about patient safety is a result of critical values. The aim of this study is to analyze the critical values of the patients which are expected to influence the patient safety. Materials and Methods. This study is an observational study with cross-sectional design. The research method used in this study is an analytic observation by pulling data from the laboratory information system and then processed using univariate anivariate analysis. Results. This research acquired 1000 critical value data, and 768 of them that fulfilled the requirements are analyzed. The percentage of critical value reported is 100%. The categories of examination results consist of hematology, clinical chemistry, blood gas analysis, and electrolytes. The highest frequencies of critical values parameters are platelet count, sodium level, pH of blood and total bilirubin level. Turn-around times of 4 categories consecutively are blood gas analysis (1 minute 21 seconds), clinical chemistry (1 minute 23 seconds), electrolytes (1 minute 12 seconds), and hematology (1 minute 20 seconds). After that, this study performed ANOVA test resulted in p> 0.05 which means that the four categories are not significantly different. Conclusions. Critical value reporting has been done well, but has not shown a difference between pediatric and adult patients. This result supports the patient safety program. It needs regular monitoring and evaluation (monev) on the management of laboratory critical values to impove patient safety.

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“…In clinical activity, the term "critical value" was defined first by George D. Lundberg in 1972 as a laboratory test result that represents a pathophysiologic state at such variance with normal as to be life-threatening unless something is done promptly and for which some corrective action could be taken (1)(2)(3)(4) and then plays an important role in ensuring patient safety and supporting effective clinical decision-making (5). Similarly, in health management and examination activity, there exist critical values in health checkup, which is represented as the important abnormal results of a certain system or an organ that is found by the physical examinee without symptoms and signs, including clinical critical values, major diseases and their clues, acute and chronic lesions, and abnormal examination results requiring dynamic observation (6).…”

Section: Introductionmentioning

confidence: 99%

Prevalence, Association Relation, and Dynamic Evolution Analysis of Critical Values in Health Checkup in China: A Retrospective Study

Chen

Liu

et al. 2021

Front. Public Health

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Objective: The critical values in health checkup play a key role in preventing chronic diseases and different types of cancer. This study aimed to analyze the prevalence, association relation, and dynamic evolution of critical values in health checkups at a large physical examination center in China.Methods: Herein, we chose 33,639 samples of physical examiners from January 2017 to December 2019. After strict exclusion processes, combined with the critical values in health checkup reporting data, 4,721 participants with at least one critical value were included. We first defined a critical value list for laboratory test, imaging, cervical cancer screening, electrocardiogram, and health checkup informed on site, and then performed a cross-sectional study to analyze the distribution and significance of critical values of 4,721 participants from different views and the association relation of 628 participants with more than one critical value and a retrospective cohort study to analyze the incidence and dynamic evolution of critical values based on 2,813 participants attending the physical examination from 2017 to 2019.Results: A total of 4,721 participants were included in the retrospective study. The prevalence of 10 critical values from 33,639 participants was over 0.6%. The critical values of obesity, hypertension, Glucose_T, Liver_T, Kidney_T, Lipid_T, Urine_T, and Head_CT were significantly increased in men (P < 0.05), whereas the results were the opposite for the Blood_T and Thyroid_US (P < 0.01). The prevalence trend of critical values increased along with age, where the prevalence of men was higher than that of women under 60 years old (P < 0.01), while the prevalence of women increased by four times and exceeded the prevalence of men above 70 years old. Association relation analysis identified 16 and 6 effective rules for men and women, respectively, where the critical values of Urine_T and Glucose_T played the central roles. Furthermore, a retrospective dynamic evolution analysis found that the incidence of new critical values was about 10%, the incidence of persistent critical values was about 50%, and that most of the effective evolution paths tended to no critical values for men and women.Conclusion: In conclusion, this study provides a new perspective to explore the population health status using the critical value reporting data in a physical examination center, which can assist in decision-making by health management at the population level and in the prevention and treatment of various types of cancer and chronic diseases at the individual level.

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The critical value concept in clinical laboratory

Cited by 11 publications

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Necessity of Routine Repeat Testing of Critical Values in Various Working Shifts

Necessity of Routine Repeat Testing of Critical Values in Various Working Shifts

Performance of Laboratory Critical Value on Clinical Laboratory Services in Supporting Patient Safety

Prevalence, Association Relation, and Dynamic Evolution Analysis of Critical Values in Health Checkup in China: A Retrospective Study

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