Collaborative Laboratory Services

Laboratory Turn-around Times and Critical Values

Document Number: QAQC.32-009

Laboratory Turn-around Times and Critical Values

Document Number:QAQC.32.ProcVersion:009

Manual: Quality Assurance Quality ControlPublish Date: May, 2012

1.0Clinical Purpose:

1.1All Results which fall into the range of “Call or Panic Values” must be called to the appropriate Unit/Doctor’s Office/Nursing Home within 30 minutes of generated result.

1.2It is the responsibility of the reporting technologist to call the “Call or Panic Value” result(s). The supervisor should be notified if the report cannot be given. The person giving the result mustprovide two patient identifiers. The person receiving the results must be a licensed caregiver and must verify the report by repeating back the test name and test results. Documentation of the call is required in the Laboratory Information System (LIS) by appending the result with “CRB”the time the result was called and the full name of the person to whom the result was given (ex. –CRB-;1300-;Jim Smith).

1.3SFH-Microbiology—If the patient has been discharged from the hospital, call the ordering physician if a private physician or an attending physician. If a resident was the ordering physician, call the Chief Resident of the specialty area caring for the patient (for example Medicine or Surgery). If unsuccessful, call the Pathologist on call with the information.

1.4If the responsible licensed caregiver or physician does not take a critical result, a Confidential Incident Report should be completed and forwarded to Risk Management.

1.5Extended delays in patient reporting are communicated electronically via email or verbally to nurse supervisors and/or managers.

1.6If the patient has been discharged from the hospital, call the ordering private physician or an attending physician.

1.7Draw Times:

1.7.1In-patient STAT requests will be drawn within 30 minutes of request.

1.7.2Hospital Out-patient STAT requests will be drawn within 2 hours of request.

1.7.3CLS Out-Patient Stats available 4-6 hours from request of blood draw.

CLS Out-patient(Nursing Homes, Physician office’s and Draw Stations)

1.8Result Intervals: (Specimen Receipt to Test Completion)

1.8.1Emergency / STAT specimenswithin 1 hour

1.8.2Blood Gas specimens (STAT)within 15 minutes

1.8.3CLS Out-Patient Stats available 4-6 hours from request of blood draw.

1.8.4Stroke Protocol---PT/INRwithin 30 minutes

1.8.5Routine Specimenswithin 4 hours

1.9Refer to chart on the following page for the defined critical ranges.

Laboratory Call and Panic Values

Attachment 1A: Adult Laboratory Call and Panic Values

The person giving the result mustprovide two patient identifiers.

The person receiving the results must be a licensed caregiver and must verify

the report by repeating back all results

CHEMISTRY / HEMATOLOGY
Critical Test / Adult
Critical Value / Critical Test / Adult
Critical Value
Acetaminophen, µg/mL / 100 / Hematocrit, % / 20.0
Bilirubin, total, mg/dL / 15.0 / Platelet count, K/µL / 25
BUN, mg/dL / 100 First value only / WBC, K/µL / ≤ 1.5 or ≥40.0
Calcium, mg/dL / 6.5 or 13.0 / Presence of Plasmodium/Babesia species in peripheral blood
CO2, mmol/L / 10 or 40 First value only
Digoxin, ng/mL / 2.6 / COAGULATION
Glucose, mg/dL / 45 or 500 / INR / ≥ 5.0
Ionized Calcium, mmol/L / 0.8 or >1.6 / PTT, sec / ≥ 110
Lithium, mEq/L / >1.5 / Heparin PF4 Antibody Screen / Presumed positive
Magnesium, mg/dL / 0.8 or 5.0
Phenobarbital, µg/mL / 60.0 / BLOOD GAS
Phenytoin, µg/mL / 30.0 / pH / 7.2 or 7.6
Potassium, mmol/L / 2.8 or 6.0 / pCO2, MMHG / 20 or 76
Sodium, mmol/L / 120 or 160 / pO2, MMHG / 40
Troponin I, ng/mL / > 0.4 First value only
MICROBIOLOGY
Positive blood cultures
Positive CSF gram stain and cultures

Attachment 1B Neonatal Laboratory and Panic Values

CHEMISTRY / HEMATOLOGY
Critical Test / Neonatal
Critical Value / Critical Test / Neonatal
Critical Value
Calcium, mg/dL / 7.0 or >13.0 / Hemoglobin, gm/dL / ≤ 8.0 or ≥24.0
Glucose, mg/dL / <40 or >200 / Platelet Count, K/µL / ≤50 or ≥ 1,000
Potassium, mmol/L / <2.5 or >6.0 / WBC, K/µL / ≤ 2.0 or ≥ 34.0
Sodium, mmol/L / <125 or >160
Neonatal Bilirubin, mg/dL / > 15.0 / BLOOD GAS
pCO2, MMHG / <30 or > 50
pO2, MMHG / <40 or >90
pH / < 7.2 or >7.5

Attachment 1C: Antepartum Laboratory and Panic Values

(The following values will be considered critical results for pregnant women located in Labor and Delivery, 4-1, and 4-9).

CHEMISTRY / HEMATOLOGY
Critical Test / Pregnancy
Critical Value / Critical Test / Pregnancy
Critical Value
AST (SGOT), U/L / > 72 / Hematocrit, % / < 25.0
ALT (SGPT), U/L / > 66 / Hemoglobin, gm/dL / < 8.0
LDH, U/L / > 620 / Platelet Count, K/µL / <100
Creatinine, mg/dL / > 1.2
Bilirubin, mg/dL / > 1.3 / COAGULATION
Magnesium, mg/dL (patient on Magnesium sulfate) / 8.0 / Fibrinogen, mg/dL / < 300
Creatinine Clearance, mL/min / < 100 / FSP, µg/mL / > 40
24 hour urine protein, mg/24 hours / > 300

Attachment 1D: Pulmonary Laboratory and Panic Values

Blood Gas
Critical Test / Pulmonary
Critical Value
pCO2, MMHG / <30 or > 50
pO2, MMHG / 60
pH / < 7.25 or >7.60

2.0References:

Laboratory Turn-around Times and Critical Values, CLS Procedure, QAQC.32.1.Chart, March 2010.

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