Evaluation of Serum and Whole Blood Sodium Critical Values

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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“…In our series none of the 8 patients with hyponatremia and hyperglycemia died. The mortality risk is reversed for hypernatremia, in which case children showed a 25% mortality rate with sodium levels .170 mmol/L, compared to 47% to 75% in adults with sodium levels of .155 mmol/L [4,7]. Table 4.…”

Section: Discussionmentioning

confidence: 99%

“…The mean low critical value cutoff was 121 mmol/L, while the mean high cutoff value was 156 mmol/L. Howanitz and Howanitz [4] evaluated clinical outcome and health care provider responses to different sodium values in adults. In their institution, 0.6% sodium results fell <120 mmol/L or were >155 mmol/L, clinicians responded to more than 50% of results within 4 hours, and mortality rates of hyponatremic and hypernatremic inpatients were 19% and 48%, respectively.…”

Section: Introductionmentioning

confidence: 99%

Study of Outcomes Associated with Hyponatremia and Hypernatremia in Children

et al. 2011

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Sodium is usually included in hospitals' critical values lists; however, the values at which sodium is considered to be life threatening (critical) vary among hospitals. Studies of outcomes associated with hyponatremia and hypernatremia in pediatric patients have not been published. We performed a retrospective chart review of sodium values of <124 mmol/L and >155 mmol/L that occurred during a 6-month period. Univariate and multivariate analyses for mortality risk were performed with the different variables. A total of 702 (1.32%) sodium tests fell in the study reference range, with 166 being <124 mmol/L and 536 being >155 mmol/L. Although not statistically significant, mortality was higher (38.5%) in patients with sodium values ≤ 120 mmol/L than in those with values ≥ 170 mmol/L (25%) or in patients with other values (<14%). Underlying conditions prevented assessment of morbidity associated with hyponatremia or hypernatremia. Treatment was instituted within 4 hours in 80% of cases (50% within 1 hour). Multivariate analysis showed increased risk of death for hyponatremic patients if they were premature or had heart abnormalities, while for hypernatremic patients the risk increased when other critical values were present. In conclusion, sodium levels of ≤ 120 mmol/L and ≥ 170 mmol/L have increased mortality in children; however, the risk of death is not statistically different when compared to risk in patients with milder hyponatremia and hypernatremia. Risk factors for death in hyponatremic and hypernatremic patients may primarily reflect the severity of the underlying conditions present in these children, such as prematurity and heart abnormalities, rather than the sodium derangement.

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“…In patients with hypocalcemia, the most common diagnoses were trauma, gastrointestinal disorders, and renal failure. 13 Often, in the latter condition, hypocalcemia can be controlled with supplemental vitamin D. In the outpatient setting, the INR showed the highest test volume. This may be because outpatients with a "red" level of criticality, which we indicate as truly lifethreatening.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Effectiveness of a Computerized Notification System for Reporting Critical Values

et al. 2009

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Failure to adequately communicate a critical laboratory value is a potential cause of adverse events. Accreditation requirements specify that clinical laboratories must undertake assessments and appropriate measures to improve the timeliness of critical value reporting and prompt receipt by the responsible caregiver. Documentation and communication processes must be regularly monitored and implemented under ongoing systems for quality monitoring. Critical value reporting is an important phase of the clinical laboratory testing process, and notifications of results outside the target time can indicate ineffectiveness of the process. In the present study, we report data obtained in a 12-month period of critical values analysis and describe a computerized communication system conducive to improving the quality of critical value reporting at a university hospital. Automated communication improves the timeliness of notification and avoids the potential errors for which accreditation programs require read-back of the result. The communication also improves the likelihood of reaching the physician on call and may provide important decision support.

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Evaluation of Serum and Whole Blood Sodium Critical Values

Cited by 32 publications

References 8 publications

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

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

Study of Outcomes Associated with Hyponatremia and Hypernatremia in Children

Evaluation of Effectiveness of a Computerized Notification System for Reporting Critical Values

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