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Rapid Communication of Laboratory Results:
Critical Results, Critical Tests, and Courtesy Calls
Department of Clinical Laboratories
POLICY: Critical tests, critical results, and courtesy calls on inpatients, outpatients, and outreach
patients will be communicated to a clinical professional responsible for the patient’s care, and
notification documented, in a consistent and timely manner.
Critical Tests:
1. Critical tests are those tests which will always require rapid communication of the results, even if
normal.
2. Critical test specimens should be delivered to the Clinical Laboratories within 10 minutes of
order/collection.
3. Critical tests will be communicated to a clinical professional responsible for the patient’s care,
regardless of the test result, within specified time interval from order/collection to reporting (see
below). Such notification will be documented.
CRITICAL TESTS
Notification: Order/Collect To Result
Code Blue Whole Blood Gas Labs 30 minutes
Critical Care Whole Blood Gas Labs 30 minutes
Frozen Sections 30 minutes
Intra-Operative PTH 40 minutes
Critical Results / Critical Values
1. Critical results, also known as “critical values,” are test results that fall significantly outside the normal
range and may represent life-threatening values, even if from routine tests.
2. Critical results (see Clinical Laboratories Critical Results Table below) will be communicated to a
clinical professional responsible for the patient’s care within 20 minutes of completion of the test, and
such notification documented as a component of the test results report.
Courtesy Telephone Notification
1. Courtesy telephone notification for other specified tests/results will be communicated to a clinical
professional responsible for the patient’s care and such notification documented as a component of
the test results report.
GENERAL PROCESS:
When rapid communication of laboratory results is required, testing and client services personnel of the
Clinical Laboratories notify a clinical professional (e.g. RN, physician, nurse practitioner, respiratory
therapist) responsible for the patient's care using the following general procedure.
1. Determine the location from which the patient specimen was sent. If the area that submitted the
specimen is closed, the laboratory will call the ordering physician, attending physician, on-call
physician, or designee (as indicated by the client).
2. Call the area that submitted the specimen and tell them you have a laboratory result to report. Ask
for a clinical professional taking care of the patient. Report ALL of the following elements:
a. your first and last name and laboratory from which you are calling
b. patient's name
c. patient’s MRN
d. patient phone number: for all non-inpatients or non-ED patients’ notifications
Effective Date: June 7, 2011 Page 1 of 4
Rapid Communication of Laboratory Results:
Critical Results, Critical Tests, and Courtesy Calls
Department of Clinical Laboratories
e. name of attending physician
f. collect date and time of specimen
g. test name(s)
h. test results
3. If the communication for an inpatient or ED patient is not to a physician and the clinical professional
indicates that the patient has been discharged, request the name of the attending physician and notify
them directly. If unable to notify the attending physician, proceed to Section 6.
4. Request read-back verification of the test result(s). This must include patient name, MRN, test
name(s) and test result(s).
5. Document telephone communications / notifications. Include all of the following elements:
a. First and last name and title (e.g. Dr. or RN) of person notified / who verified/read-back
the results
b. Date of notification
c. Time of notification
6. If the appropriate person cannot be reached (especially after “business hours”), the laboratory staff
will consult with the pathologist to determine whether the patient needs to be contacted directly and
advised to seek medical attention. If so, the pathologist will contact the patient. If not, the laboratory
will notify the appropriate person the next morning.
Effective Date: June 7, 2011 Page 2 of 4
Rapid Communication of Laboratory Results:
Critical Results, Critical Tests, and Courtesy Calls
Department of Clinical Laboratories
Notes Key: Outpatients only (ED is outpatient) Neonate/Pediatric only James Patients only
CHEMISTRY HEMATOLOGY
Analyte Critical Results Analyte Critical Results
Acetone-serum/plasma Moderate or higher WBC < 1.5 > 35.0 K/uL
ALT initial only > 1000 U/L BMT J8E, J8S < 0.5 > 35.0 K/uL
AST initial only > 1000 U/L 10J initial only
Amylase > 500 (> 400 under 18 yr) U/L Known CLL > 100.0 K/uL outpatients only
Beta Hydroxybutyrate > 1.1 mmol/L Other Oncology < 0.5 > 35.0 K/uL
Bilirubin, total > 14.0 mg/dL (neonates only) Hemoglobin < 7.0 > 22.0 g/dL
BUN > 100 mg/dL Neonates < 11.0 > 22.0 g/dL
NEPH initial only > 100 mg/dL Hematocrit < 21.0 > 66.0 %
Calcium <6 > 12 mg/dL Neonates < 33 > 66.0 %
Chloride < 75 > 130 mmol/L Platelet < 30 > 1,000,000 K/uL
CO2 < 10 > 40 mmol/L Oncology < 10 > 1,000,000 K/uL
Creatine Kinase > 500 U/L (outpatients only ) Bands + Segs Ratio > 0.25 (Neonates only)
GCRC Mendell: do not call CSF WBC > 10 cells / uL
Mendell ICD9 = 359.1outpatients: do not call Bacteria Any intracellular on peripheral blood smear,
Creatinine > 10 mg/dL Any on direct smear of any sterile body fluid OR
NEPH initial only > 10 mg/dL count if direct smear is not already positive
Ethanol > 0.300 g/dL
Free T4 (ED only) > 4.5 ng/dL
Glucose < 50 > 400 mg/dL
Neonates < 40 > 200 mg/dL COAGULATION
CSF Glucose < 30 > 300 mg/dL Analyte Critical Results
Lactate > 5.0 mmol/L INR > 5.5
Lithium > 2.0 mmol/L PTT > 150 sec (inpat) > 60 (outpat)
Phosphorus < 1.0 > 10 mg/dL Fibrinogen < 75 mg/dL
Ionized Calcium < 3.4 > 6.2 mg/dL Factor Activity < 5%
Magnesium < 1.0 > 4.4 mg/dL
Osmolality < 250 > 325 mOsm/kg
Potassium < 3.0 > 6.0 mmol/L URINALYSIS
Neonates < 3.0 > 7.0 mmol/L Analyte Critical Results
Sodium < 125 > 160 mmol/L Urine Microscopic Any RBC casts
pH < 7.2 > 7.55 Any WBC casts
pCO2 < 20 > 65 mmHg Pediatric < 2 yrs Positive for reducing substance
pO2 <44 mmHg Children < 7 yrs Positive for glucose
Troponin I > 5.00 FIRST critical result, additional Myoglobin Positive
calls ONLY if no previous >5.00 Porphobilinogen Positive
within past 24 hours.
TSH (ED only) >150.0 uIU/mL
Effective Date: June 7, 2011 Page 3 of 4
Rapid Communication of Laboratory Results:
Critical Results, Critical Tests, and Courtesy Calls
Department of Clinical Laboratories
Notes Key: Outpatients only (ED is outpatient) Neonate/Pediatric only James Patients only
MICROBIOLOGY THERAPEUTIC DRUGS
Positive Blood Culture Analyte Critical Results
Positive direct smear and/or culture of any sterile body fluid Acetaminophen > 150 ug/mL
Positive direct smear and/or culture from any central nervous Amikacin Peak > 60 ug/mL; Trough > 8 ug/mL
system specimen Carbamazepine > 15 ug/mL
Positive Malaria smear Digoxin > 2.0 ng/mL
Positive AFB smear / Tissue section Free Phenytoin > 3.0 ug/mL
Positive Fungal smear Gentamicin Peak > 20 ug/mL; Trough > 2.0 ug/mL
Cultures positive for M. tuberculosis, Brucella, Legionella, Lidocaine > 6.0 ug/mL
or any Class A reportable disease Lithium > 2 mmol/L
Neisseria meningitidis invasive disease Pentobarbital > 45 ug/mL
Diseases of the newborn, e.g. Group B beta Streptococci, CMV, Phenobarbital > 45 ug/mL
HSV, H. influenza, Listeria spp., Neisseria gonorrhoeae, Phenytoin > 22 ug/mL
Chlamydia trachomatis Salicylate > 30.0 mg/dL
Positive Epstein-Barr Virus by PCR – blood or CSF Theophylline > 20 ug/mL
Positive Clostridium difficile tests Tobramycin Peak > 20 ug/mL; Trough > 2.0 ug/mL
Positive Influenza A/B tests: antigen, PCR and/or culture Valproic Acid > 150 ug/mL
Vancomycin > 20 ug/mL Trough
TRANFUSION SERVICES
Newborn Positive Direct Coombs Test Positive Kleihauer-Betke stain
(DAT) Titer > 32 in pregnancy
Hemolytic Transfusion Reaction Suspected passenger lymphocyte syndrome
Clerical or technical error(s)
Effective Date: June 7, 2011 Page 4 of 4
