title: Prevalence and Clinical Utility of "Incidental" Critical Values Resulting From Critical Care Laboratory Testing.
abstract: OBJECTIVE
  Panels of clinical laboratory testing may generate "incidental" critical values from unordered parameters. Existing regulations do not clearly delineate guidelines for handling incidental critical values. The objective of this study was to examine the patterns and clinical utility of incidental critical values at 2 critical care laboratories within an academic medical center.
  
  
  METHODS
  In this retrospective study, the electronic health record and laboratory information system were reviewed for incidental critical results obtained from blood gas analyzer analysis of whole blood specimens between November 2010 and August 2014.
  
  
  RESULTS
  Within the retrospective time period, 9,092 incidental critical results were documented, of which only 11.8% were added to the "parent" order following clinical notification. Incidental critical results frequently occurred in patients who had recent critical values for the same parameter.
  
  
  CONCLUSIONS
  In this study, at an academic medical center, incidental critical values associated with blood gas analyzers were added on at a low rate and often provided redundant information. Relative to the manual effort involved in care providers' notification and documentation of results, incidental critical values appear to have low clinical utility.
authors.affiliation: Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA.
authors.forename: Caleb V
authors.initials: CV
authors.lastname: Grieme
authors.affiliation: Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA.
authors.forename: Dena R
authors.initials: DR
authors.lastname: Voss
authors.affiliation: Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA.
authors.forename: Karin E
authors.initials: KE
authors.lastname: Olson
authors.affiliation: Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA.
authors.forename: Scott R
authors.initials: SR
authors.lastname: Davis
authors.affiliation: Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA.
authors.forename: Jeff
authors.initials: J
authors.lastname: Kulhavy
authors.affiliation: Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA matthew-krasowski@uiowa.edu.
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Krasowski
mesh_terms: D000046:Academic Medical Centers; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D019411:Clinical Laboratory Techniques / Q000379:methods*; D003422:Critical Care / Q000379:methods*; D016638:Critical Illness; D005260:Female; D006801:Humans; D033162:Incidental Findings; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D055815:Young Adult
keywords: blood gas analysis; clinical chemistry; hematology; incidental findings; lactic acid