Evaluation of critical value and urgent sample notification at clinical biochemistry laboratory in a tertiary care hospital
Keywords:Alert value, Urgent sample, Critical value notification
Background: Critical value and urgent sample result notification is widely accepted in the diagnostic fraternity as an important factor, as it may affect patient care and safety. Timely release and notification of these test result as per the individual laboratory protocol becomes an internal part of quality reporting system. The present study was aimed at evaluating the effective implementation of the existing protocol of urgent clinical notification (UCN) in the clinical biochemistry laboratory of tertiary care hospital and evaluating the turnaround time for urgent samples and critical results listed under UCN protocol in the clinical biochemistry laboratory.
Methods: A prospective, observational study was conducted in clinical biochemistry laboratory of a tertiary care hospital. Descriptive statistics was calculated for all the data by Mann-Whitney and Wilcoxon test.
Results: Majority of the critical results were informed to the clinical personnel by the clinical laboratory. Out of 4687 critical results, 25.41% critical results were informed directly to the ward through telephonic communication. Documentation of critical values in the dedicated register and lab information system (LIS) was 25.41% and 40.28% respectively. 421 (9%) out of 4687 critical results were not notified. The median turnaround time for all urgent tests and critical results was found to be 72.33 minutes and 76.00 minutes respectively.
Conclusions: This study highlighted various approaches to improve the critical value notification and its turnaround time and status of UCN in laboratory
Report of the Second Phase of the Independent Review of NHS Pathology Services in England. Chaired by Lord Carter of Coles. Available at: http://webarchive.nationalarchives.gov.uk/20130107105354, http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_091984. Accessed on 8 September 2022.
Piva E, Pelloso M, Penello. L, Plebani M. Laboratory critical values: automated notification supports effective clinical decision making. Clin Biochem. 2014;47:1163-8.
Rocha BCB, Alves JAR, Pinto FPD, Mendes ME, Sumita NM. The critical value concept in clinical laboratory. J Bras Patol Med Lab. 2016;52(1):17-20.
Campbell C, Caldwell G, Coates P, Flatman R, Georgiou A, Horvath AR et al. Consensus statement for the management and communication of high risk laboratory results. Clin Biochem Rev 2015;36(3):97-105.
Wager EA, Friedberg RC, Souers R, Stakovic AK. Critical values comparison. A college of American Pathologists Q-Probes Survey of 163 laboratories. Arch Pathol Lab Med. 2007;131:1769-75.
Casalino LP, Dunham D, Chin MH, Bielang R. Frequency of Failure to Inform Patients of Clinically Significant Outpatient Test Results. Arch Intermed. 2009;169(12):1123-9.
Valenstein PN, Wagar EA, Stankovic AK, Walsh MK, Schneider F. Notification of critical results: a College of American Pathologists Q-Probes study of 121 institutions. Arch Pathol Lab Med. 2008;132(12):1862-7.
Agarwal R, Chaturvedi S, Chhillar N, Goyal R, Pant I, Tripathi CB. Role of intervention on laboratory performance:Evaluation of quality indicators in a tertiary care hospital. Ind J Clin Biochem. 2012;27(1):61-8.
Hawkins RC. Laboratory turnround time. Clin Biochem rev. 2007;28(4):179-94.
Plebani M, Carraro P. Mistakes in a stat laboratory: types and frequency. Clin Chem. 1997;43:1348-51.
Mangukiya SJ, Tailor PB, Patel SM, Patel R, Soni K. Analysis of Laboratory Critical Value Reporting Pattern at Clinical Biochemistry Laboratory of Tertiary health care Center. Int J Biomed Adv Res. 2015;6(08):617-22.
Schoen C, Osborn R, Doty MM, Bishop M, Peugh J, Murukutla N. Toward higher performance health systems: adults health care experiences in seven countries, 2007. Health Aff (Millwood). 2007;26(6):w717-34.
Tate KE, Gardner RM. Computers, quality and the clinical laboratory: a look at critical value reporting. Ann Symp Comp Appl Med Care. 1993:193-7. PMID: 8130460; PMCID: PMC2248502.
Lewandrowski K. How the clinical laboratory and the emergency department can work together to move patients through quickly. Clin Leadersh Manag Rev. 2004;18:155-9.
Fernandes CM, Worster A, Eva K, Hill S, McCallum C. Pneumatic tube delivery system for blood samples reduces turnaround times without affecting sample quality. J Emerg Nurs. 2006;32:139-43.