Wongkrajang Preechaya, Leelanuwatkul Saharat, Nuanin Sairung, Laiwejpithaya Sathima
Department of Clinical Pathology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
PLoS One. 2025 Jun 9;20(6):e0324594. doi: 10.1371/journal.pone.0324594. eCollection 2025.
Critical laboratory values are life-threatening results that necessitate immediate medical intervention. Reporting these values according to established guidelines is essential for ensuring optimal patient safety and care quality. The aim of this study was to evaluate the laboratory critical value reporting system and the actions taken at Siriraj Hospital - Thailand's oldest and largest teaching hospital - during January 2018. This study reviewed critical values from hematology, coagulation, and clinical chemistry tests over a one-month period. Patient management actions in response to critical values were classified into five categories: treatment, further investigation, monitoring, treatment combined with investigation, and other. Descriptive statistics were used to analyze the data in Microsoft Excel 2019, calculating the incidence of critical values, notification rates, and management actions. Of the 253,537 tests that were performed, 2,722 critical levels were found, indicating an incidence rate of 1.1%. Hemoglobin and potassium were the most frequently observed critical parameters, accounting for 25.61% and 23.99% of cases, respectively. The rate of notification varied depending on the specific parameter and patient category. For critical glucose and potassium levels, the most common response was close monitoring within 30 minutes, followed by treatment in 80% of cases. Hypermagnesemia, a condition linked to preeclampsia and treated with magnesium sulfate, required particularly careful monitoring. The 1.1% incidence of critical values in this study is high compared to previously published international data; however, this may be explained by the high volume of complex cases referred to our national tertiary referral center. Critical value reporting criteria should be established based on patient conditions and hospital management practices to reduce unnecessary alerts, optimize laboratory workload, and ensure high-quality patient care.
危急检验值是危及生命的结果，需要立即进行医疗干预。按照既定指南报告这些值对于确保最佳患者安全和护理质量至关重要。本研究的目的是评估泰国最古老、最大的教学医院——诗里拉吉医院在2018年1月期间的实验室危急值报告系统及采取的行动。本研究回顾了一个月内血液学、凝血和临床化学检验的危急值。针对危急值采取的患者管理行动分为五类：治疗、进一步检查、监测、治疗与检查相结合以及其他。使用描述性统计方法在Microsoft Excel 2019中分析数据，计算危急值发生率、通知率和管理行动。在进行的253,537次检验中，发现2,722个危急水平，发生率为1.1%。血红蛋白和钾是最常观察到的危急参数，分别占病例的25.61%和23.99%。通知率因具体参数和患者类别而异。对于危急血糖和钾水平，最常见的反应是在30分钟内密切监测，80%的病例随后进行治疗。与先兆子痫相关且用硫酸镁治疗的高镁血症需要特别仔细的监测。与先前公布的国际数据相比，本研究中1.1%的危急值发生率较高；然而，这可能是由于转诊到我们国家三级转诊中心的复杂病例数量众多所致。应根据患者情况和医院管理实践制定危急值报告标准，以减少不必要的警报，优化实验室工作量，并确保高质量的患者护理。
