Analysis of Laboratory Repeat Critical Values at a Large Tertiary Teaching Hospital in China

Context: 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. Objective: 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. Methods: 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. Results: 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. Conclusions: 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