Assessment of a laboratory critical risk result notification protocol in a tertiary care hospital and their use in clinical decision making

Abstract

Introduction: Communication of laboratory critical risk results is essential for patient safety, as it allows early decision making. Our aims were: 1) to retrospectively evaluate the current protocol for telephone notification of critical risk results in terms of rates, efficiency and recipient satisfaction, 2) to assess their use in clinical decision making and 3) to suggest alternative tools for a better assessment of notification protocols. Materials and methods: The biochemical critical risk result notifications reported during 12 months by routine and STAT laboratories in a tertiary care hospital were reviewed. Total number of reports, time for the notification and main magnitudes with critical risk results were calculated. The use of notifications in clinical decision making was assessed by reviewing medical records. Satisfaction with the notification protocol was assessed through an online questionnaire to requesting physicians and nurses. Results: Critical result was yielded by 0.1% of total laboratory tests. Median time for notification was 3.2 min (STAT) and 16.9 min (routine). The magnitudes with a greater number of critical results were glucose and potassium for routine analyses, and troponin, sodium for STAT. Most notifications were not reflected in the medical records. Overall mean satisfaction with the protocol was 4.2/5. Conclusion: The results obtained indicate that the current protocol is appropriate. Nevertheless, there are some limitations that hamper the evaluation of the impact on clinical decision making. Alternatives were proposed for a proper and precise evaluation.

Evaluation of the effectiveness of critical result notification protocol of biochemistry laboratory at a tertiary care hospital

“…This wide difference in the incidence of critical values may be explained by the remarkable interlaboratory differences in the critical values notification list and the threshold values. 9,[16][17][18][19][20][21][22][23] The rate of critical value also depends on the type of patients studied, with lower rates observed in studies involving outpatients 23 and high rates in studies involving patients in the emergency department or the ICU. 16 Our study included a heterogenous mix of patients from outpatients, emergency department or ICU, and inpatients.…”

“…Corrective clinical action (treatment initiation or change of treatment) after critical value notification reported in literature ranged from 49 to 100%. 9,23 The clinical actions taken after critical result notification were analyzed within 1 week and a corrective action was taken in 91% of the patients in our study. Documentation of critical alerts was found in all the case sheets.…”

“…The analytes with the maximum critical alerts described in the literature were for potassium. 9,[16][17][18][19][20][21][22][23] Other analytes were glucose, sodium, calcium, and creatinine. The average TAT for critical value notification in our laboratory was 20 minutes.…”

“…16 This variability in TAT is attributed to different types of notification systems used to inform the critical alerts. The various methods of notification systems mentioned in literature are paging, 16 telephone calls with readback, 9,17,[19][20][21][22][23] personal digital assistance (PDA) with short messaging services (SMS), 17 laboratory information systems (LIS) with popup notifications, 9,19,[21][22][23] and e-mail. 21 The purpose of alerting a critical value is not served if there is a delay in notification.…”

“…The probability for corrective clinical action was higher in inpatients than in outpatients. 9 The impact of corrective action varied across the analytes studied. The highest clinical impact of corrective action was seen in patients with hypokalemia, hyponatremia, and hypomagnesemia.…”