Value Reporting Policy
To: Charles H. Parker, M. D., Chief of
From: John B. Carter, M. D.,
Director of Clinical Laboratories
Subject: Alert Value Reporting
Date: July 12, 2005
-- Prompt phone reporting of significantly abnormal laboratory test results
is important if these results reflect an abnormality that may require
immediate modification of patient therapy.
That is a simple and straightforward premise
-- and we have been following some form of that policy for over 20 years.
As this policy is a direct result of laboratory testing and has a direct
impact on patient care, the operational features of Alert-value reporting
require input from LMC's Medical Staff. Some features that require
What tests and what range of
abnormalities warrant 24/7 phone call alerts?
Should repeat alert values be called if
the abnormality persists in a testing series?
Who should be called?
While LMC's Laboratory team has phoned
abnormal results since the old days of "Panic Values" (which we changed to
"Alert" values), JCAHO requirements have recently mandated detailed
documentation of the process. Thus the call must be made, results must be
read back, and documentation of the call recorded on both ends.
The medical staff retains the responsibility
to determine what tests and what abnormality ranges fall within 24/7 alert
(A copy of current Alert Ranges is enclosed
for your comments and suggestions.)
Regarding repeat alert values,
there is occasional sentiment that all Alert Value results should be
called. This leads to the redundant situation of calling repeat
thrombocytopenias in chemotherapy patients, elevated BUN and creatinine
results in dialysis patients, etc.
All laboratory reports are immediately
electronically transferred to the floor and immediately printed. All
results are immediately available online, and all results are added daily to
the cumulative summary lab report each night. Therefore there seems to be
no necessity and much unnecessary effort (on both ends) involved with repeat
calling of repeated Alert Range abnormalities. We suggest discontinuance of
Who should be called:
This can be complex on evenings, nights and holidays. Strictly
speaking, the physician who ordered the test should be notified. The
nurse-in-charge can easily be called w/ in-patient Alerts, with her/his
discretion and knowledge of the proper physician notification.
Outpatient Alerts may be more
complex, and we'll appreciate your suggestions on OP call thresholds.
Please let me know and thank
you for your time and ideas.
|(posted 13 June 2005)
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