Point-of-Care Technologies Center and Pathology and Laboratory Medicine, Pathology and Laboratory Medicine, School of Medicine, University of California, Davis, USA.
Clin Chem Lab Med. 2011 Feb;49(2):167-76. doi: 10.1515/CCLM.2011.033. Epub 2010 Nov 22.
The objectives of this article were 1) to identify current trends in critical values practices in North America, Europe, and other regions; 2) to describe progress toward harmonization of critical limits; and 3) to synthesize strategies that will encourage global consensus. Critical limits are described in national surveys. Critical value practices are guided by federal statutes, The Joint Commission regulations, and accreditation requirements in the US; by provincial healthcare agencies in Canada; by thought leaders and ISO EN 15189:2007 in Europe; and in SE Asia, mostly by ad hoc policies lacking statutory grip.
Review of databases, literature, websites, federal statutes, litigation, official policies, current affairs, and accreditation agency requirements.
Practical strategies will accelerate harmonization of critical values practices, as follows: a) continue national and international survey comparisons; b) clarify age, ethnic, and subject dependencies; c) standardize qualitative and quantitative decision levels for urgent clinician notification; d) monitor compliance and timeliness for safety; and e) alert high frequencies of critical values related to adverse events. New expectations and communication technologies present opportunities for enhanced performance using wireless closed-loop reporting with recipient acknowledgment to reduce phone calls and improve efficiency. Hospitals worldwide can benefit from developing consensus for critical values practices.
本文的目的是：1）识别北美、欧洲和其他地区危急值实践的当前趋势；2）描述危急限值协调的进展；3）综合鼓励全球共识的策略。临界极限在国家调查中进行描述。危急值实践受美国联邦法规、联合委员会法规和认证要求的指导；受加拿大省级医疗机构的指导；受欧洲思想领袖和 ISO EN 15189:2007 的指导；在东南亚，主要是通过缺乏法定控制的特别政策。
审查数据库、文献、网站、联邦法规、诉讼、官方政策、时事和认证机构要求。
以下是加速危急值实践协调的实用策略：a）继续进行国家和国际调查比较；b）澄清年龄、种族和主题依赖性；c）为紧急临床医生通知标准化定性和定量决策水平；d）监测安全性的合规性和及时性；e）警惕与不良事件相关的危急值的高频发生。新的期望和通信技术为使用带有收件人确认的无线闭环报告提高性能提供了机会，以减少电话并提高效率。全球的医院都可以从制定危急值实践的共识中受益。
