The Laboratory Calls The Following Abnormal Values:
All phone calls made to report critical values are documented in the Laboratory Information System. To comply with patient safety goals, the person taking the call must read back the patient’s name, the hospital number and all laboratory results.
Blood Bank Diagnostic Significant Values
| The Pathology resident will notify the responsible physician in the following critical circumstances: | |
| 1. | Transfusion Reaction concerning any labeling errors, positive test results or if hematuria/hemoglobinuria is checked on the symptom sheet. |
| 2. | If crossmatch compatible Red Blood Cells cannot be found. |
| 3. | Culture positive blood products. |
| Blood Bank staff will notify the responsible physician: | |
| 1. | When Red Blood Cell antibodies are identified in a patient and the responsible physician has not ordered Red Blood Cells or the patient is having surgery. |
Hematology
Critical values will be called to every patient care area and clinic location in addition to the computer filing of results.
See the University of Iowa Hospitals and Clinics, Policy and Procedure Manual for Reporting of Critical Test Results.
|
Less Than or Equal to
|
Greater Than or Equal to
|
|
| Fibrinogen |
80 mg/dl
|
|
| Hematocrit |
18%
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55% (adult)
|
| Hemoglobin |
6 gm/dl
|
22 gm/dl (adult)
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| HIT (Heparin dependent antibody) |
Results: Positive
|
|
| INR (venous) |
4.0
|
|
| Platelet Count |
10 k/mm3
|
1,000 k/mm3
|
| PTT (Outpatient only) |
50 seconds
|
|
| White Blood Count (WBCT) |
1.0 k/mm3
|
50.0 k/mm3
|
Microbiology
Critical or Significant values: patient results are called to the physician or service area as soon as results are available.
1. Critical value patient results include:
a. Positive direct examination from sterile body fluid/site
1) Cerebrospinal fluid
2) Joint fluid
3) Pericardial fluid
4) Pleural fluid
5) Peritoneal fluid
b. Positive blood culture (initial gram stain report)
c. Positive Legionella pneumophila antigen (also page on-call epidemiologist)
d. Positive Cryptococcus neoformans antigen
2. Significant patient results include:
a. Positive STAT gram stain results
b. Negative STAT gram stain results from the Operating Room
c. Positive direct examination from intraoperative specimens
d. Positive culture of sterile body fluid (Do not call identical result within 5 days)
1) Cerebrospinal fluid
2) Joint fluid
3) Pleural fluid
4) Pericardial fluid
5) Peritoneal fluid
6) Intraoperative body fluids
e. Positive malaria smears
f. Positive direct antigen tests
1) Pneumocystis carinii
2) Streptococcus agalactiae
3) Clostridium difficile
4) Cryptosporidium spp.
5) Giardia lamblia
6) Herpes Simplex (HSV)
7) Varicella-Zoster (VZV)
8) Rotavirus
9) Respiratory viruses - Adenovirus, Influenza A and B, Parainfluenza 1,2,3 and Respiratory syncytial virus (RSV)
g. Significant serology results
1) Positive Lyme Serology confirmed by Western Blot
2) Positive Toxo IgM confirmed by reference laboratory
h. Epidemiology considerations (call to floor)
1) Methicillin-resistant Staphylococcus aureus
2) Vancomycin-resistant enterococci
3) Extended spectrum β-lactamases
i. Epidemiology considerations (call floor and on-call epidemiologist pager)
1) Acid-fast bacilli smear
2) M. tuberculosis (culture or UHL PCR)
3) Legionella pneumophila (urine antigen or growth from environmental culture)
4) Neisseria meningitidis (CSF gram stains with gram negative diplococci or growth from normally sterile site)
5) Category A bioterrorism agents (Bacillus anthracis, Yersinia pestis, Francisella tularensis,
Clostridium botulinum toxin, Smallpox, Viral hemorrhagic fever)
j. Culture or molecular detection of following organisms from any source:
(If patient is from OB/GYN do not call results unless the organism is isolated from blood or normally sterile body fluids.)
1) Streptococcus pyogenes
2) Pathogenic Neisseria
3) Virus culture
4) Chlamydia, Herpes Simplex (HSV), or Enterovirus PCR
5) Dimorphic fungi
k. Positive ocular cultures (other than conjunctiva)
l. Culture of stool pathogens
1) Salmonella spp.
2) Shigella spp.
3) Campylobacter spp.
4) Yersinia spp.
5) Escherichia coli H7;O157
m. Culture of potential bioterrorism agents
1) Francisella tularensis
2) Bacillus anthracis
3) Brucella spp.
4) Yersinia pestis
5) Coccidiodes immitis
3. Calling Algorithm:
Follow Department of Pathology guidelines (500.020) entitled "Reporting Critical Tests and Critical Values." This policy defines authorized staff that may accept critical values and provides a detailed calling algorithm. The results must be "read back" by the authorized staff and the call documented in body of CERNER report using the CALL template.
For OB/GYN patients only smear or culture results from blood cultures and normally sterile body fluid specimens are phoned on a STAT basis.
Significant results called to physicians or service areas must be documented in a CALL report.
Ocular Pathology
Unexpected surgical pathology findings (such as unexpected malignancy or unexpected pathogen): the pathologist will report findings to the contributing physician. Verbal communication will be documented in the “Comments” section of the written report.