title: Global trends in critical values practices and their harmonization.
abstract: BACKGROUND
  The objectives of this article were 1) to identify current trends in critical values practices in North America, Europe, and other regions; 2) to describe progress toward harmonization of critical limits; and 3) to synthesize strategies that will encourage global consensus. Critical limits are described in national surveys. Critical value practices are guided by federal statutes, The Joint Commission regulations, and accreditation requirements in the US; by provincial healthcare agencies in Canada; by thought leaders and ISO EN 15189:2007 in Europe; and in SE Asia, mostly by ad hoc policies lacking statutory grip.
  
  
  METHODS
  Review of databases, literature, websites, federal statutes, litigation, official policies, current affairs, and accreditation agency requirements.
  
  
  CONCLUSIONS
  Practical strategies will accelerate harmonization of critical values practices, as follows: a) continue national and international survey comparisons; b) clarify age, ethnic, and subject dependencies; c) standardize qualitative and quantitative decision levels for urgent clinician notification; d) monitor compliance and timeliness for safety; and e) alert high frequencies of critical values related to adverse events. New expectations and communication technologies present opportunities for enhanced performance using wireless closed-loop reporting with recipient acknowledgment to reduce phone calls and improve efficiency. Hospitals worldwide can benefit from developing consensus for critical values practices.
authors.affiliation: Point-of-Care Technologies Center and Pathology and Laboratory Medicine, Pathology and Laboratory Medicine, School of Medicine, University of California, Davis, USA. gjkost@ucdavis.edu
authors.forename: Gerald J
authors.initials: GJ
authors.lastname: Kost
authors.forename: Kristin N
authors.initials: KN
authors.lastname: Hale
mesh_terms: D019963:Clinical Chemistry Tests / Q000592:standards*; D016638:Critical Illness; D006801:Humans; D007391:International Cooperation; D038622:Internationality; D010372:Pediatrics; D012016:Reference Values