CRITICAL VALUES, CRITICAL TEST RESULTS AND SIGNIFICANT FINDINGS LIST

Transcription

1 Page 1 of 7 Affected Sites: X Enterprise Chandler Good Samaritan CRITICAL VALUES: Critical Values are defined as an analytic result that suggests a clinical condition that may be life- threatening and may require immediate clinical intervention: a qualitative result or pathological interpretation that may impact patient care and may require timely clinical intervention. BLOOD BANK: 1. Any of the following during investigation of a transfusion reaction: a. Visible unexplained hemolysis in post-transfusion reaction patient sample b. New incompatible crossmatch of transfused product c. Clerical or serological error that could cause acute hemolysis in patient, such as Group A red cells transfused to Group 0 patient. d. Presence of positive gram stain or culture of implicated blood component 2. Incompatible crossmatch of red cells transfused as uncrossmatched. 3. Positive culture of transfused platelet pheresis product. CLINICAL LAB: Test Name Critical Value Absolute count neutrophil <1.0 k/µl Bilirubin 6 days 6 weeks 12.0 mg/dl Calcium Calcium, Ionized Carbon dioxide Fibrinogen Glucose, plasma 3-5 days >12.0 mg/dl >13.0 mg/dl < 6.0 mg/dl <3.0 mg/dl 6.5 mg/dl 40 mmol/l 10 mmol/l < 80 mg/dl > 1 year 50 mg/dl or 500 mg/dl Glucose, spinal fluid Hematocrit 0 days 1 year 40 mg/dl or 300 mg/dl <40 mg/dl <19.5%

2 Page 2 of 7 Test Name Critical Value Hemoglobin < 6.5 g/dl Anti-Xa Unfractionated >1.00 IU/mL Low Molecular Weight Lactate (whole blood) Lactate (plasma/fluid) Lithium Rapid Malaria screen Malaria smear Magnesium >2.00 IU/mL >8.0mmol/L >8.0 mmol/l 1.5 mmol/l Positive Positive 1.0 mg/dl (non-ob patients) 4.5 mg/dl Partial thromboplastin time (inpatient) >120 sec (outpatient) > 60 sec Prothrombin Time INR > 6.0 pco2 60 mm Hg ph Phosphorus 1.0 mg/dl po2, Arterial Platelet count Potassium Sodium WBC count (adult) HIV 1/HIV 2 Confirmation newborn: (inpatient) (outpatient) (infant <30 days) 60 mm Hg 50 mm Hg or 300 mm Hg < 20 k/µl or >1,000 k/µl 6.5 mmol/l 2.6 mmol/l 6.0 mmol/l 2.6 mmol/l 165 mmol/l 120 mmol/l < 2.0 k/µl or > 80.0 k/µl < 5.0 k/µl Any Result Supratherapeutic Drug Levels Acetaminophen >35 µg/ml Amikacin trough >10 µg/ml Carbamazepine Digoxin Lithium >35 µg/ml >15.0 µg/ml > 2.3 ng/ml 1.5 mmol/l

3 Page 3 of 7 Test Name Critical Value Phenobarbital Phenytoin > 45.0 µg/ml >22.0 µg/ml Salicylate Theophylline COPD >30 mg/dl >22 µg/ml Theophylline premature apnea (0-3 months) >13 µg/ml Vancomycin trough 25.0 µg/ml >50.0 µg/ml Cyclosporine transplant >400 ng/ml Gentamicin trough >2.0 µg/ml Sirolimus >10.0 µg/ml >15 ng/ml Tacrolimus transplant >25 ng/ml Tobramycin trough >2.0 µg/ml >10.0 µg/ml Modified Critical Value List for Emergency Departments at Chandler and Good Samaritan Hematocrit < 19.5% ph Platelet count < 20 k/µl Potassium 6.5 mmol/l 2.0 mmol/l Sodium 165 mmol/l 120 mmol/l Glucose, plasma > 1 year < 50 mg/dl 0 days 1 year < 40 mg/dl CYTOGENETICS Positive result for PML/RARA FISH for evaluation of acute promyelocytic leukemia (APL) MICROBIOLOGY: Positive blood cultures smears Positive AFB smears Positive GeneXpert MTB/rif result Positive Gram stains on CSF Positive test result on the Biofire ME Panel Recovery of organisms from smear negative CSF

4 Page 4 of 7 MICROBIOLOGY: (cont) Recovery of Mycobacterium tuberculosis when a negative smear or GeneXpert MTB result has been reported Positive fungal direct exam (KOH) on sterile body sites Positive Fungal cultures on sterile body sites if the direct exam (KOH) was negative Recovery of yeast from sterile body fluids if the direct exam (KOH) was negative Recovery of Pseudomonas species from eye cultures Positive Cryptococcal Antigen Positive HSV PCR on CSF Positive CMV PCR (blood) (first positive result) Positive Streptococcus pneumonia antigen on CSF Positive PCR for E coli 0157H7 or positive result for Shiga toxin stx1/stx2 detection from stool NOTE: All critical values called to the Emergency Department need to be reported to the attending physician ANATOMIC PATHOLOGY RESULTS: Any tests requiring a professional interpretation may be called to the attending at the discretion of the pathologist reviewing the case. A list of critical results developed by consensus is below. This communication will be noted in the final report. Bone Marrow Findings: Unexpected malignancy New or relapsing leukemia Presence of infectious organisms not previously known to clinician Other unusual or significant findings at the discretion of the faculty member Cytopathology findings: Unexpected malignancy Malignancy (suspected or not) in critical location (e.g., superior vena cava syndrome, risk of spinal cord injury) All new diagnosis blastic/high grade leukemias/lymphoma Immunocompromised patients with bacteria or any fungi in CSF; Pneumocystis, fungi, or viral cytopathic effect in pulmonary specimens; bacteria or fungi in FNA; and acid fast bacilli in any specimen All new diagnosis Pneumocystis, fungi (except for Candida) or viral cytopathic effect in pulmonary specimens; fungi in FNA or CSF specimen; acid fast bacilli in any specimen Significant disagreement between immediate and final diagnosis Surgical Pathology findings: Unexpected malignancy The presence of infectious organisms not previously known to the clinician (exception: dermatophytes, histoplasmosis-like organisms in old granulomas)

5 Page 5 of 7 Surgical Pathology findings: (cont) Transplant rejection Significant disagreement between frozen section and final diagnosis Crescents in kidney biopsy specimen Vasculitis (examples: temporal arteritis, large vessel vasculitis) Bacteria in heart biopsy specimen Absent villi from suspected intrauterine pregnancy Fat in endometrial curettage specimen Mesothelial cells in heart biopsy specimen Malignancy in superior vena cava syndrome or causing paralysis Absent ganglion cells in initial rectal biopsies from infants REFERENCE LABORATORY: Fetal Hemoglobin by Flow Cytometry Positive galactomannan Positive Histoplasma and Blastomyces urinary antigen Positive CMV PCR all sites on send outs (First time only) Positive EBV PCR on CSF (First positive result) Positive Enteroviral PCR on CSF or blood (First positive result) Positive Creutzfeldt-Jakob disease (CJD) result Notify Infection Control who will notify Hospital Safety Officer Positive VZV PCR on CSF (First positive result) Western Blot Positive for HIV Positive Bordetella pertussis by PCR Positive Chlamydia trachomatis culture Reporting of Communicable Diseases Reporting of communicable disease results to Infection Prevention and Control Department (IPAC) will be dictated by UK HealthCare Policy and Procedure A Reporting Communicable Diseases and 902 KAR 2:020: Amended Table of Reportable Disease and Conditions in Kentucky as intermittently updated (Latest version effective November 16, 2016). HISTOCOMPATIBILITY TESTING: The following test results will be called to referring physicians regardless of the result Prospective deceased donor crossmatch (all called) Prospective living donor crossmatch initial and final (all called) Retrospective deceased donor crossmatch (all called) STAT donor specific antibody (all called)

6 Page 6 of 7 HISTORY: BLOCK: Replaces: LAB Significant Updated procedure name from CRITICAL VALUES, SIGNIFICANT FINDINGS LIST and STAT Changes: RESULTS to Removed Absolute neutrophil count (Ascites or Peritoneal fluid) critical value: 250 µl Removed Sentinel Event from Bilirubin Removed 0 days 11 years from Glucose, spinal fluid >11 years Added: Glucose, spinal fluid <40 mg/dl Changed Hematocrit from <15% to <19.5% Changed Hemoglobin from <5.0g/dl to < 6.5 g/dl Changed units of measure for Anti-Xa Unfractionated >1.00 IU to >1.00 IU/mL Low Molecular Weight >2.00 IU to >2.00 IU/mL Changed Malaria Screen Prep to Rapid Malaria Screen Added: Malaria Smear Changed Platelet count from < 10 kµ/l or >1,000 kµ/l to < 20 k/µl or >1,000 k/µl Changed WBC count for (infant <5 days) < 5.0 k/µl to WBC count for (infant <30 days) < 5.0 k/µl Changed Modified Critical Value List for Chandler Emergency Department ONLY to Modified Critical Value List for Emergency Departments at Chandler and Good Samaritan Changed Modified Critical Value List for Emergency Departments at Chandler and Good Samaritan Hematocrit from <15% to <19.5% Added: CYTOGENETICS Positive result for PML/RARA FISH for evaluation of acute promyelocytic leukemia (APL) to the critical value list Updated Bone Marrow findings to include Other unusual or significant findings at the discretion of the faculty member Updated Bone Marrow findings to include relapsing leukemia Added All critical values called to the Emergency Department need to be reported to the attending physician to the Microbiology section Added: Positive Chlamydia trachomatis culture to Reference Laboratory listing Added: Histocompatibility Testing to the critical value list Prospective deceased donor corssmatch (all called) Prospective living donor crossmatch initial and final (all called) Retrospective deceased donor crossmatch (all called) STAT donor specific antibody (all called Removed The following tests are ed to Infection Control nurses for inpatients for isolation purposes: Multi Drug Resistant Organisms Positive Bordetella pertussis by PCR Positive Clostridium difficile by PCR Positive Legionella urinary antigen or positive culture

7 Page 7 of 7 Positive culture for MTB Positive MTB PCR on all sources Positive Varicella zoster PCR or culture Positive PCR for Campylobacter species Positive PCR for E. coli 0157H7 or stx1/stx2 positive results from CGIPCR Panel Positive PCR for RSV or influenza Positive PCR for Salmonella species Positive PCR for Shigella species Positive PCR for Rotavirus Positive PCR for Vibrio Species Positive PCR for Norovirus Added: Reporting of Communicable Diseases Reporting of communicable disease results to Infection Prevention and Control Department (IPAC) will be dictated by UK HealthCare Policy and Procedure A Reporting Communicable Diseases and 902 KAR 2:020: Amended Table of Reportable Disease and Conditions in Kentucky as intermittently updated (Latest version effective November 16, 2016). Minor Changes: APPROVAL BLOCK: Written by: Barbara Bush Date: Revised by: Leola Hampton Date: 10/12/2018 Approved by: Jeff Bush Approval Date: 10/26/2018 Jeff Bush, enterprise Director Laboratory Services Effective Date: 11/13/2018 Medical Director: Biennial Review Date: Date procedure retired: Approved by: Amy Gewirtz, MD CLIA Designated Director Date: 10/26/2018