Department of Laboratory Medicine, University-Hospital of Padua, Padua, Italy.
Clin Chem Lab Med. 2010 Apr;48(4):461-8. doi: 10.1515/CCLM.2010.096.
Critical value reporting is considered an essential tool to ensure the quality of medical laboratory services. Important issues include defining cut-off values, assessing responsibility for communication and adopting information technology solutions to improve notification. Here, we report the state of critical value reporting in a large cohort of Italian laboratories and comparison with Q-Probes surveys from the College of American Pathologists as representatives of the US situation.
To compare critical value policies and procedures, formulation of critical values list with critical values limits and monitoring tools, a web-based questionnaire was formulated for 389 institutions participating in the External Quality Assessment Schemes of Veneto Region, in Italy.
A total of 90 clinical laboratories submitted data. Accredited laboratories represented 82.2% of participants, but written procedures for reporting were indicated by 70.5% of participants. Relevant differences between US and Italian policies have been observed, particularly regarding who provides the notification and on the formulation of the cut-off threshold for critical values.
Accreditation according to international standards can decrease differences regarding the management of critical values across laboratories of different countries. However, the issues concerning critical limits should be debated and a consensus critical values list should be considered. Automated systems could offer improvements regarding some issues, such as who makes the notification, reducing the time spent in notification of critical values. Surveys for comparing and improving existing policies regarding critical values should be promoted at an international level.
临界值报告被认为是确保医学实验室服务质量的重要工具。重要问题包括定义截止值、评估沟通责任以及采用信息技术解决方案以改进通知。在这里，我们报告了意大利一大群实验室的临界值报告情况，并与美国病理学家学院的 Q-Probes 调查进行了比较，以代表美国的情况。
为了比较临界值政策和程序、临界值列表的制定与临界值限值和监测工具，我们为参加威尼托地区外部质量评估计划的 389 个机构制定了一个基于网络的问卷。
共有 90 个临床实验室提交了数据。认可的实验室占参与者的 82.2%，但有 70.5%的参与者表示有报告临界值的书面程序。观察到美国和意大利政策之间存在显著差异，特别是关于谁提供通知以及临界值的截止阈值的制定。
根据国际标准进行认证可以减少不同国家实验室之间临界值管理方面的差异。然而，临界值限值的问题应该进行讨论，并应考虑制定共识临界值列表。自动化系统可以在一些问题上提供改进，例如谁进行通知，从而减少临界值通知的时间。应在国际层面上推广比较和改进现有临界值政策的调查。
