Harmonization of critical result management in laboratory medicine

Campbell, Craig; Horvath, Andrea R.

doi:10.1016/j.cca.2013.11.004

Cited by 51 publications

(56 citation statements)

References 31 publications

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“…Although critical results comprise just up to 2% of all laboratory results, it is the MBL’s responsibility to monitor this important part of the post-analytical phase ( 11 , 17 ). Accreditation and patient safety standards require MBLs to have a management system for timely and reliable critical results notification.…”

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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“…Efforts aimed at harmonizing results such as the critical value limits for the INR should be encouraged, as it will lead to less confusion for busy physicians treating patients at multiple institutions, all with different critical value limits. Such discussions have started worldwide 27 with recommendations by Kost and Hale 28 widely circulated. As a first step, we would recommend that those with critical INR limits far from the median reconsider their limits and chose a limit closer to our median or to the median described by Pai et al 21 International normalized ratio is one of the most important laboratory tests, as the reproducibility of the result is one of the most important quality attributes of a clinical laboratory.…”

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confidence: 99%

Assessing Clinical Laboratory Quality: A College of American Pathologists Q-Probes Study of Prothrombin Time INR Structures, Processes, and Outcomes in 98 Laboratories

Howanitz

Darcy

Meier

et al. 2015

Archives of Pathology &Amp; Laboratory Medicine

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“…The most extreme measure of clinical outcome is mortality, and laboratories usually try to define critical risk limits to trigger the immediate notification of such results to clinicians. The methods laboratories use to establish their critical limits vary [64][65][66][67]. State of the art approaches are common including borrowing critical limits from other laboratories, critical limit surveys [68,69] or the literature, in general [70].…”

Section: Critical Risk Limits and Critical Changesmentioning

confidence: 99%

Performance criteria of the post-analytical phase

Sikaris¹

2015

Clinical Chemistry and Laboratory Medicine (CCLM)

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Quality in healthcare is ideally at an optimal benchmark, but must be at least above the minimal standards for care. While laboratory quality is ideally judged in clinical terms, laboratory medicine has also used biological variations and state-of-the-art criteria when, as is often the case, clinical outcome studies or clinical consensus are not available. The post-analytical phase involves taking quality technical results and providing the means for clinical interpretation in the report. Reference intervals are commonly used as a basis for data interpretation; however, laboratories vary in the reference intervals they use, even when analysis is similar. Reference intervals may have greater clinical value if they are both optimised to account for physiological individuality, as well as if they are harmonised through professional consensus. Clinical decision limits are generally superior to reference intervals as a basis for interpretation because they address the specific clinical concern in any patient. As well as providing quality data and interpretation, the knowledge of laboratory experts can be used to provide targeted procedural knowledge in a patient report. Most profoundly critically abnormal results should to be acted upon to minimise the risk of mortality. The three steps in quality report interpretation, (i) describing the abnormal data, (ii) interpreting the clinical information within that data and (iii) providing knowledge for clinical follow-up, highlight that the quality of all laboratory testing is reflected in its impact on clinical management and improving patient outcomes.

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Harmonization of critical result management in laboratory medicine

Cited by 51 publications

References 31 publications

Croatian survey on critical results reporting

Croatian survey on critical results reporting

Assessing Clinical Laboratory Quality: A College of American Pathologists Q-Probes Study of Prothrombin Time INR Structures, Processes, and Outcomes in 98 Laboratories

Performance criteria of the post-analytical phase

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