Clin Chem Lab Med. 2014 Dec;52(12):1739-45. doi: 10.1515/cclm-2014-0331.
Early notification of critical values by the clinical laboratory to the treating physician is a requirement for accreditation and is essential for effective patient management. Many laboratories automatically repeat a critical value before reporting it to prevent possible misdiagnosis. Given today's advanced instrumentation and quality assurance practices, we questioned the validity of this approach. We performed an audit of repeat-testing in our laboratory to assess for significant differences between initial and repeated test results, estimate the delay caused by repeat-testing and to quantify the cost of repeating these assays.
A retrospective audit of repeat-tests for sodium, potassium, calcium and magnesium in the first quarter of 2013 at Tygerberg Academic Laboratory was conducted. Data on the initial and repeat-test values and the time that they were performed was extracted from our laboratory information system. The Clinical Laboratory Improvement Amendment criteria for allowable error were employed to assess for significant difference between results.
A total of 2308 repeated tests were studied. There was no significant difference in 2291 (99.3%) of the samples. The average delay ranged from 35 min for magnesium to 42 min for sodium and calcium. At least 2.9% of laboratory running costs for the analytes was spent on repeating them.
The practice of repeating a critical test result appears unnecessary as it yields similar results, delays notification to the treating clinician and increases laboratory running costs.
临床实验室将危急值及时通知给主治医生是获得认证的要求，也是有效患者管理的关键。许多实验室在报告危急值之前会自动重复检验以防止可能的误诊。鉴于当今先进的仪器和质量保证实践，我们质疑这种方法的有效性。我们对实验室的重复测试进行了审核，以评估初始和重复测试结果之间是否存在显著差异，估算重复测试造成的延迟，并量化重复这些检测的成本。
对 2013 年第一季度泰格伯格学术实验室进行的钠、钾、钙和镁重复测试进行了回顾性审核。从我们的实验室信息系统中提取初始和重复测试值以及进行测试的时间的数据。采用临床实验室改进修正案允许误差标准来评估结果是否存在显著差异。
共研究了 2308 次重复测试。其中 2291 次（99.3%）的样本无显著差异。平均延迟时间从镁的 35 分钟到钠和钙的 42 分钟不等。至少有 2.9%的分析物实验室运行成本用于重复检测。
重复危急值检测结果的做法似乎没有必要，因为它会产生相似的结果，延迟了对主治医生的通知，并增加了实验室的运行成本。
