title: Study of variables affecting critical value notification in a laboratory catering to tertiary care hospital.
abstract: During post-analytical phase, critical value notification to responsible caregiver in a timely manner has potential to improve patient safety which requires cooperative efforts between laboratory personnel and caregivers. It is widely accepted by hospital accreditors that ineffective notification can lead to diagnostic errors that potentially harm patients and are preventable. The objective of the study was to assess the variables affecting critical value notification, their role in affecting it's quality and approaches to improve it. In the present study 1,187 critical values were analysed in the Clinical Chemistry Laboratory catering to tertiary care hospital for neuropsychiatric diseases. During 25 months of study period, we evaluated critical value notification with respect to clinical care area, caregiver to whom it was notified and timeliness of notification. During the study period (25 months), the laboratory obtained 1,279 critical values in clinical chemistry. The analytes most commonly notified were sodium and potassium (20.97 & 20.8 % of total critical results). Analysis of critical value notification versus area of care showed that critical value notification was high in ICU and emergency area followed by inpatients and 64.61 % critical values were notified between 30 and 120 min after receiving the samples. It was found that failure to notify the responsible caregiver in timely manner represent an important patient safety issue and may lead to diagnostic errors. The major area of concern are notification of critical value for outpatient samples, incompleteness of test requisition forms regarding illegible writing, lack of information of treating physician and location of test ordering and difficulty in contacting the responsible caregiver.
authors: Department of Neurochemistry, Institute of Human Behaviour & Allied Sciences, Delhi, 110095 India.
authors: Rachna
authors: R
authors: Agarwal
authors: Department of Neurochemistry, Institute of Human Behaviour & Allied Sciences, Delhi, 110095 India.
authors: Neelam
authors: N
authors: Chhillar
authors: Department of Biostatistics, Institute of Human Behaviour & Allied Sciences, Delhi, 110095 India.
authors: Chandra B
authors: CB
authors: Tripathi
keywords: Alert value; Critical value notification; LIS; Panic value; Turnaround time
references: Am J Clin Pathol. 2006 May;125(5):758-64
references: 16707379
references: Clin Chim Acta. 2009 Jun;404(1):52-8
references: 19306860
references: Arch Pathol Lab Med. 2002 Jun;126(6):663-9
references: 12033953
references: Am J Clin Pathol. 2012 Jan;137(1):164; author reply 165
references: 22180492
references: Arch Pathol Lab Med. 2007 Dec;131(12):1769-75
references: 18081434
references: Clin Chem Lab Med. 2010 Apr;48(4):461-8
references: 20128733
references: Clin Chem. 2010 Mar;56(3):417-23
references: 20040617