Jun 28, 2022

Biochemistry and Haematology Critical Values Policies Across the GTA

Laboratories Policies Survey: key findings

All surveyed institutions follow a similar framework with regards to critical values policies:

There is a defined list of tests that warrant having critical value(s) in place in consultation with clinical stakeholders
Critical results are primarily flagged/identified by the Laboratory Information System (LIS)
Laboratory staff are primarily responsible for immediate communication of critical values
The minimum information to be communicated to clinical staff includes test name, test result and patient name, all of which must be read back to laboratory staff
There is documentation of critical value communication primarily within the LIS

There is opportunity for improvement with respect to auditing and quality management for critical values systems across all institutions

The frequency and stakeholders involved with periodic audits of critical values is not well-defined across institutions
Few laboratories monitor quality indicators/measures such as:
- Time elapsed between identification and receipt of critical results
- Critical results flagging rates

Critical Values Survey: key findings

Across 16 participating institutions, we identified a total of 93 tests within Biochemistry and Haematology/Coagulation with critical values - see the downloadable PDF for a full list of tests.

Of note, there was considerable variability for population-specific critical values across institutions.

Characteristics used to define a specific population included: sample type, age, inpatient/outpatient status, anticoagulant status

The following tests are likely to be “harmonizable” with respect to critical values within the GTA as they displayed the least variability across institutions:

Low Critical Value

pCO₂
pO₂
Glucose
Magnesium
Osmolality
Sodium
Fibrinogen
Neutrophils

High Critical Value

pCO₂
Bicarbonate
Calcium, total
Calcium, ionized
Osmolality
Phosphate
Hemoglobin
INR
Platelets
Gentamicin, pre-dose
Phenobarbital
Theophylline
Tobramycin, pre-dose
Vancomycin, pre-dose

Summary and recommendations

This initial assessment into current critical values practices and thresholds has identified commonalities and differences across GTA hospitals. Although it is premature to provide recommendations on the “appropriate” critical values policies, these findings will serve as a foundation for subsequent consensus building with key stakeholders.

The ultimate goal will be to develop and disseminate standardized critical values policies wherever appropriate and possible for the GTA.

Authors / contact

Compiled by

Dr. Felix Leung

Assistant Professor, Department of Laboratory Medicine & Pathobiology, University of Toronto, Clinical Biochemist, Mount Sinai Hospital

felix.leung@sinaihealth.ca

Contributors

Dr. Saranya K. Arnoldo
Assistant Professor, Department of Laboratory Medicine & Pathobiology, University of Toronto
Clinical Biochemist, William Osler Health System

saranya.arnoldo@williamoslerhs.ca

Dr. Daniel R. Beriault
Assistant Professor, Department of Laboratory Medicine & Pathobiology, University of Toronto
Head of Biochemistry, Unity Health Toronto

Daniel.Beriault@unityhealth.to

Dr. Davor Brinc
Assistant Professor, Department of Laboratory Medicine & Pathobiology, University of Toronto
Clinical Chemist, University Health Network

davor.brinc@uhn.ca

Dr. Paul Yip
Associate Professor, Department of Laboratory Medicine and Pathobiology, Sunnybrook Health Science Centre and University of Toronto

paul.yip@utoronto.ca

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