Critical Values Comparison: A College of American Pathologists Q-Probes Survey of 163 Clinical Laboratories (Cap Laboratory Improvement Programs)
Critical values reporting is the mechanism by which direct reporting of potentially life-threatening laboratory results is made to caregivers. First described by Lundberg more than 30 years ago, (1) clinical laboratories identify critical results that may be life-threatening and contact physicians so that immediate clinical intervention may be initiated. Since this first report, the use of critical values reporting was adopted as a requirement in the Clinical Laboratory Improvement Amendments (CLIA ’88). (2) Specifically, the laboratory is directed to “immediately alert the individual or entity requesting the … test results when any test result indicates an imminently life threatening condition, or panic or alert values.” (2) More recently, national health care accreditation agencies, such as the Joint Commission (JC), have established standards requiring critical values reporting as part of health care ex cellence. (3) Notably, the JC now views not only laboratory results but other types of imaging and diagnostic studies as critical results. Critical values laboratory reporting, although widely accepted as exceedingly important to patient care and safety, can be problematic for the individual clinical laboratory. This may be because the definition of a critical value continues to evolve. It probably also relates to the different needs of clinicians and their various clinical services. Moreover, the reporting of critical values in the literature is varied and somewhat limited. (4-6) Individual institutions may report their experience, (5) or more general lists are sometimes provided as overviews. (6) The College of American Pathologists (CAP) similarly reports on critical values practices. (4) Despite these clinical resources, clinical laboratories may have difficulty determining the best mechanism for creating a critical values analyte list. Also, clinical laboratories frequently question how their critical values analyte lists and procedures compare to those of other institutions.