A critical laboratory result is one that has been identified as representing a

potentially dangerous or life threatening state in which immediate medical action

is necessary. All critical test results are immediately communicated to the
attending physician or appropriate clinical personnel responsible for that
patient�s care.

Every effort will be made to reach the most responsible physician. In the event
that the physician is unavailable to receive the result, the Laboratory Medical
Director will be notified in order to take the next steps to ensure that the
patient receives the proper care in a timely manner.

Inpatient critical results

The Laboratory Technologist will:

Notify the nursing staff on the patient�s unit to relay the result to the ordering
physician.
Indicate that this is a critical value and that the physician must be notified
immediately.
Document all actions and ask that the information be read back by the person
receiving it to confirm accuracy of the communication.
Outpatient critical results

During regular office hours the Laboratory Technologist will:

Call the physician�s office during their regular working hours.

If the physician is not available, the result will be given to the office RN.
Indicate that this is a critical value and that the physician must be notified
immediately.
Document all actions and ask for read back to ensure information was communicated
accurately.
After hours, on weekends or statutory holidays

If the patient has been discharged or is an outpatient, the lab staff at the
testing site will call the ordering physician�s on-call number.

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In order to ensure timely completion of critical tests and receipt of critical

results, the principles of performance improvement (PI) must be implemented. For
all critical tests, the acceptable time from order to result being available must
be identified by each organization, cognizant of the time it actually takes to
complete various diagnostic tests, i.e., imaging studies verses laboratory testing.
For critical results, the acceptable time from result being available until it is
received by the licensed practitioner empowered to take action on the result, must
be identified. Once these times have been identified, data regarding any delay in
timely completion of a critical test and communication of the critical result or
delay in timely receipt of a critical result must be collected, aggregated and
relayed to leadership for analysis and action.

Critical Test Measurement Parameter:

Elapsed time from the time the test was ordered to the time the result (whether
normal or abnormal) is reported to a responsible licensed care giver (that is, the
turnaround time of the critical test).

Critical Result Measurement Parameter:

Elapsed time from when the critical (abnormally high or low) result was determined
to be critical to the result is first known to the time it is reported to the
licensed responsible caregiver (that is, the result known-to-reporting interval).
Suggested Policy for Critical Tests
All diagnostic tests ordered "STAT" or "Now" will be considered to be critical
tests. These include tests performed in the laboratory, in imaging, and in
cardiology, if the ordering practitioner is not the person performing the
diagnostic test. The ordering practitioner is expected to indicate the date and
time the order is written. Staff authorized to receive a verbal or telephone
order for a critical test must also include the date and time the order is
received. Staff processing (transcribing) the critical test order will communicate
to the department/service/area performing the test the critical nature of the test
to expedite its timely completion. The results of all critical tests will be
immediately communicated to the ordering practitioner whether abnormal or not.
Should the time from ordering the critical test to the availability of its result
exceed ________ for laboratory tests or _________for non-laboratory tests, the
administrative supervisor will be notified immediately. A decision will then be
made as to an alternate practitioner to receive the result of the critical test.
Alternate recipients of the critical test result might include another member of
the ordering practitioner's group practice, the physician member of the rapid
response team, the ED physician, the hospitalist, and medical staff leaders.

Suggested Policy for Critical Results

All diagnostic tests resulted as a critical/panic value/red level will be
communicated to the ordering practitioner within _____, including those tests
ordered for completion in a routine fashion, such as next day. Should the time
from the critical test result being available until its communication to the
ordering practitioner exceed _______, the _____ will be notified immediately.
Likewise, this individual will also be notified for any delay of more than _____ in
communicating the critical test result to the ordering practitioner. The same
process will be followed as in the situation above when an alternate recipient of a
critical test result must be identified.

Laboratory staff will call the nurse providing care to the patient to
telephonically relay all critical test results and all critical results performed
in the laboratory. The nurse will document and read back the result of the test,
as per policy _______. The nurse will also document the date and time of receipt,
the person calling the result, and include their own name and title.

Critical tests and critical results for those tests performed outside the
laboratory (imaging and cardiac testing) require direct practitioner-to-
practitioner communication. The practitioner receiving the result of a critical
test or a critical result is expected to repeat back the information they have
received. To ensure patient safety, the nurse providing care to the patient will
also be notified. This notification need not follow the same path as the
communication to the licensed practitioner.

All critical tests completed beyond the accepted time and all delays in
communicating critical results to the licensed practitioner will be reported to
_____. A monthly report will be generated and forwarded to the PI office. These
data will be presented for analysis at the quarterly _______ meeting. Data
regarding any delay in contacting the licensed practitioner will also be forwarded
to the medical staff leadership for analysis and action.