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Critical Tests and Critical Values: Definition, Turn-around Time, Performance Monitoring

Critical Tests

Only the tests listed in Attachment I shall be considered “critical” for the purpose of this policy. Adherence to the time frames specified is expected and routine reporting is not required unless otherwise indicated.

Critical Results / Values

Although there are a number of results that are considered critical by the testing department, the medical staff has determined that the values listed in Attachment II are so important that they should be communicated to a responsible caregiver (either a physician or another care giver with the ability to adjust therapy in response to the value) as soon as possible.

Either the testing department or nursing shall immediately attempt to contact the responsible caregiver upon receipt of a critical value listed in Table II. These attempts shall continue until a responsible caregiver is notified.

If a responsible caregiver cannot be found within [1 hour] [45 minutes] [30 minutes] from the time the result was available, the testing department or nursing shall contact the [physician on duty in the emergency department] [rapid response team] [other] of the value. It shall become that person’s responsibility to take any actions appropriate to care for the patient.

When receiving a critical value verbally, all staff and physicians shall first write the value onto a piece of paper or into the computer then read the value back to assure accurate transmission. It is not necessary to document this read-back process.

Should it take longer than [1 hour] [45 minutes] [30 minutes] from the time the result became available to notify the responsible care giver of the critical value, an incident report shall be completed and forwarded to [the Performance Improvement Department]. [Performance shall be routinely monitored in the manner specified in the Quality Assurance and Performance Improvement plan.]

Attachment I: Critical Tests

Test / Expected time frame from order to result available
Initial Troponin level / 30 minutes
STAT CAT Scan from the emergency department
Etc.

Attachment II: Critical Values / Results

Value / Result
Laboratory Values
Bicarbonate [range] (first level only)
CKMB [range] (first level only)
Glucose [range]
Phosphorus [range]
Potassium [range]
Sodium [range]
Troponin [range] (first level only)
[other]
Imaging Results
Cerebral bleed
Ectopic pregnancy
Ischemic bowel
Pulmonary embolism
Ruptured aneurysm
Spinal cord compression
[other]
Echocardiology Results
Cardiac Tamponade
[other]