Critical Values: The definition of “Panic (Critical) Value Test Results” is a diagnostic test result that requires an urgent response. A critical value is defined as a value that represents such variance with normal (expected values) as to be life-threatening unless something is done promptly and for which some corrective action could be taken.

  1. Notification: The patient care provider or referring laboratory is notified when critical limits of specified test results are exceeded and/or critical results are obtained. In addition to the normal results reporting (e.g. computer interface), laboratory staff will telephone the ordering physician or the client-provided contact number within 15 minutes following laboratory release of the critical result(s). In the event that contact is not made within the 15-minute period, the lab will continue to telephone until the designated party is reached and the result is conveyed.
  1. Read-Back of Critical Value / Critical Results: To verify the accuracy of patient information communicated via the telephone, the physician or designee responsible for patient care is required to read-back the patient name, unique patient numeric identification, and the critical test result(s).
  1. Documentation: The critical high and low values are documented in the laboratory’s standard operating procedure and defined in the laboratory computer information system.

Notes: Records of notification and read back are documented electronically in the laboratory information system by the laboratory staff.

NOTE: Information in this document is taken from the SFMC Lab Reporting of Criticals Procedure. The table that follows does notincludein-patient criticals for specific intensive care units.

SFMC LABORATORY CRITICAL VALUE LIST:

Hematology/Coag/Urinalysis / Critical Value
WBC (x10³/mm³) / < 1.0, >80
Hemoglobin (gm/dL) / < 5.0
Platelets (x10³/mm³) / < 20, > 1000
WBC Differentials / Blasts present
INR / > 6.0
PTT (seconds) SFMC / > 100 if new critical or more than 24 hours since the last critical of >100 ---OR---
>300 on all APTTs.
PTT (seconds) CHC Lab / 100
Fibrinogen (mg/dl) / < 100
Urine albumin in pregnancy / 4+
Pregnancy test (urine or serum) / Positive on surgical patient
Blood Bank
Confirmed hemolytic transfusion reaction
No blood available for patient due to incompatibility
No more blood products available due to depletion
Positive DAT (direct Coombs) on cord blood
Incompatibility or abnormal result found on blood already given to a patient due to an emergency
Microbiology, Serology, and Immunology
Positive Meningitis Panel on CSF
Positive Cryptococcus antigen
Positive blood culture (bacterial, fungal or AFB)
Positive CSF cultures and gram stains
Group B Streptococcus in NICU or OB
Clostridium in tissue cultures
Neisseria gonorrhoeae in eye cultures
Positive IV or other pharmacy solutions
Positive AFB cultures or smears
Positive India Ink or Cryptococcus culture
Neisseria meningitidis
Chemistry / Critical Value / Critical Value Age 0-28 days
Glucose (mg/dL) / 50, 400 / 50, > 180
Sodium (mmol/L) / 120, 160 / < 125, > 150
Potassium (mmol/L) / 2.5, 6.0
Calcium (mg/dL) / 6.5, 12.0
CO2 (mEq/L) / 14, 42
Magnesium (mg/dL) / >8.0 on OB patient
BUN / >99 if first critical
Lactic Acid (mmol/L) / 4.0
Lithium / >2.0
Acetaminophen (ug/ml) / > 70
Amikacin, trough (ug/ml) / > 15
Carbamazepine (ug/ml) / > 20
Digoxin (ng/ml) / > 2.5
Gentamicin, trough (ug/ml) / > 2.5
Lidocaine (ug/ml) / > 6.0
Phenobarbital (ug/ml) / > 60
Phenytoin (ug/ml) / > 40
Procainamide (ug/ml) / > 12
Quinidine (ug/ml) / > 6
Salicylate (mg/dl) / >40
Theophylline (ug/ml) / > 25
Tobramycin, peak (ug/ml) / > 12
Tobramycin, trough (ug/ml) / > 2
Troponin / >0.3 (initial only)
Valproic Acid (ug/ml) / >200
Vancomycin, trough / >25
HIV test / positive
Hepatitis A-IgM Ab / positive
Positive Blood-borne protozoan parasites / positive

G/Lab/#Lab Procedures/Specimen Collection/Specimen Collection Procedure/ASC.3008.H updated 4-19-18