Critical Laboratory Tests and 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.

Critical test results will be telephoned to the referring facility as soon as possible. If in the event, contact cannot be made at that time, the result will be forwarded to UI Diagnostic Laboratories Client Services for call back during business hours.

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 (including positive culture) or if hematuria/hemoglobinuria is checked on the symptom sheet.

2. If crossmatch compatible Red Blood Cells cannot be found (first event in the hospital admission).

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.

2. Positive culture results on transfused Apheresis Platelets.

Chemistry and Toxicology

*Ammonia, Cortisol serum/plasma concentrations less than 2.0 mcg/dL and phosphorus (inorganic) less than 1.0 mg/dL are treated as significant (not critical) values.

**Also applies to glucose levels determined during glucose tolerance tests.

Critical Care

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.

Requests for assistance with interpretation should be directed to UIDL Client Services at 319-356-8588 (toll-free at 1-866-844-2522).

Microbiology

Critical value patient results include:

1. Positive gram stain from sterile body fluid/site
   1. Cerebrospinal fluid
   2. Joint fluid
   3. Pericardial fluid
   4. Pleural fluid
   5. Peritoneal fluid
   6. Amniotic fluid
   7. Eye, Vitreous fluid/Aqueous fluid
   8. Body Fluid
2. Positive blood culture (initial gram stain report)
   1. The first bottle of a set is called unless morphology changes
   2. Additional sets that go positive will not be called if within 2 hours of first positive set.
3. Positive Legionella pneumophila antigen (also page on-call epidemiologist)
4. Positive Cryptococcus neoformans antigen
5. Positive malaria antigen
6. Positive Biofire Meningitis/Encephalitis (ME) Panel

Significant patient results include:

1. Positive STAT gram stain results
2. Negative STAT gram stain results from the Operating Room. If patient is out of the Operating Room when results become available, results will not be called.
3. Positive direct gram stain with hyphal forms seen, both sterile and non-sterile sites.
4. Positive direct gram stains from sources that are clinically impactful
   1. Abscess from Brain or Liver
   2. Bone (except bone flap or other non-sterile sites)
   3. Tissues (except debridement, burn or other non-sterile sites)
5. Positive culture of sterile body fluid or clinically significant site
   1. Called after identification is performed. Do not call identical identifications within 5 days.
      1. Cerebrospinal fluid
      2. Joint fluid
      3. Pericardial fluid
      4. Pleural fluid
      5. Peritoneal fluid
      6. Amniotic fluid
      7. Eye, Vitreous fluid/Aqueous fluid
      8. Body Fluid
      9. Abscess from Brain or Liver
      10. Bone (except bone flap or other non-sterile sites)
      11. Tissues (except debridement, burn or other non-sterile sites)
6. Positive Pneumocystis carinii antigen tests
7. Positive malaria smears
8. Epidemiology considerations (call floor and call or epic chat on-call epidemiologist)
1. Acid-fast bacilli smear
2. M. tuberculosis (culture or 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)
6. Multi-drug resistant gram negative rods - inpatient's only
9. 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-only from non-throat sources
2. Herpes Simplex (HSV) PCR – CSF only
3. Dimorphic fungi
4. Cryptococcus neoformans
10. Molecular detection or culture of stool pathogens
1. Salmonella spp.
2. Shigella spp.
3. Campylobacter spp.
4. Yersinia spp.
5. Escherichia coli H7;O157
6. Cryptosporidium
7. Giardia
8. Cyclospora cayetanensis
9. Vibrio cholerae
11. Culture of potential bioterrorism agents
1. Francisella tularensis
2. Bacillus anthracis
3. Brucella spp.
4. Yersinia pestis
5. Coccidiodes immitis
6. Burkholderia mallei or pseudomallei

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 Comm log.

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.

Special Care Nurseries