Critical Values – Bellingham Laboratory

Reporting of “critical values” is practiced at PeaceHealth Laboratories’ Bellingham Laboratory using the limits published below.  Laboratory results meeting these criteria indicate potential life-threatening conditions, and as such, are promptly communicatedto a physician who can initiate appropriate therapy.
See Critical Value Notification Process.

Critical Value Notification Process

It is the policy of PeaceHealth Laboratories to have the technologist performing and reporting the test to notify the appropriate person who can respond to the critical result. The person notified of “critical values”, in order of preference, is as follows:

• Hospital patients
• Blood Bank
1. Critical blood bank situations must be called to either the pathologist, patient”s physician or nurse. See table of critical situations for who must be called.
• Clinical Lab
1. The RN on duty for that patient, the nurse team leader, or the house supervisor.
2. The attending/ordering physician or physician on call.
3. The pathologist on call.
• Microbiology – Critical Isolates
1. The ordering physician (or on-call physician covering for the ordering physician; if neither can be contacted, obtain from the nursing staff the name of the attending physician to contact). The report can be given to the physician”s office personnel.
2. The nursing or ward personnel where the patient is located.
3. The medical microbiology director if no physician can be contacted, the on-call pathologist if the medical microbiology director can not be contacted.
4. Notify pharmacy and infection control personnel for all positive pharmacy products.
5. MRSA (Methicillin resistant S. aureus) isolates are called according to the following criteria:
   SBFT: call the floor and the physician.
   Non-SBFT: call the floor only.
   Emergency: SBFT – call department.
6. VRE:(Vancomycin resistant enterococci) is called in the following special circumstances in addition to when confirmed:
   Presumptive VRE (Vitekresults are vancomycin resistant or intermediate). In-patient SBFT: call floor and give verbal “possible VRE”report.
   Confirmed VRE (confirmed by 24 hour method) report according to the CriticalValue criteria listed above.
7. Positive blood and CSF specimens in which an initial gram stain was 1st reported as “GPC” must have a follow-up call to thephysician if the GPC turns out to be  S. aureus.
• Microbiology – Isolates of Elevated Importance
1. Notify the appropriate nursing area for inpatients and emergency room.
2. Notify the pharmacy for any pharmacy related cultures.
• Outpatients
1. The ordering physician”s nurse or designated office staff.
   Note: Physician offices may designate an individual other than a nurse with the authority to accept critical results.
2. The attending/ordering physician or physician on call.
3. The pathologist on call.
4. MRSA SBFT: call the physician; late evening results can wait until next day to be called.  Nursing homes: call for all new cases; late evening results can wait until next day to be called.

Updated: October 7, 2010