Department of Laboratory Medicine, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
PLoS One. 2013;8(3):e59518. doi: 10.1371/journal.pone.0059518. Epub 2013 Mar 14.
As a patient safety measure, laboratories are required to have a critical values policy by regulatory agencies. Unfortunately, little information is available on repeat critical values for the same analyte(s) on the same patient.
To investigate the occurrence and distribution of repeat critical values and the relationship between the frequency of such values and patient outcome to provide information for hospitals on improving reporting policies.
Eleven laboratory critical value lists, including chemistry and hematology analytes, were selected from a tertiary hospital in China in the year 2010. The distribution and interval time for each repeat critical value were calculated. Serum potassium and platelet count were used as examples to illustrate the relationship between the frequency of the repeat critical values and patient outcome.
All test items on the critical value list were prone to the occurrence of repeat critical values. On average, each patient who experienced critical values had 2.10 occurrences. The median interval time for each repeat critical value varied, with most being longer than 8 hours. For those patients who had repeat critical values of serum potassium and platelet count, along with the increased frequency, the patients had a longer hospital stay and a generally worse outcome.
Patient can have a number of repeat critical values and the frequency of these values is closely related to patient outcome. A careful evaluation is warranted if a laboratory chooses to adopt a policy of not reporting each repeat critical value.
作为一项患者安全措施，监管机构要求实验室制定危急值政策。然而，关于同一患者同一分析物的重复危急值的信息却很少。
研究重复危急值的发生和分布，以及这些值的频率与患者结局之间的关系，为医院改善报告政策提供信息。
从中国一家三级医院 2010 年的 11 份实验室危急值清单中选择了化学和血液分析物等内容。计算了每个重复危急值的分布和间隔时间。以血清钾和血小板计数为例来说明重复危急值频率与患者结局之间的关系。
危急值清单上的所有检测项目都容易发生重复危急值。平均每位出现危急值的患者有 2.10 次发生。每个重复危急值的中位数间隔时间不同，大多数超过 8 小时。对于那些血清钾和血小板计数有重复危急值的患者，随着频率的增加，患者的住院时间延长，总体预后较差。
患者可能会有多次重复危急值，这些值的频率与患者结局密切相关。如果实验室选择不报告每个重复危急值的政策，需要进行仔细评估。
