We at the Los Angeles County/USC Medical Center are generally credited with having created the “Panic Value” or “Critical Value” laboratory reporting system in 1969.
A Panic or Critical Value is a laboratory finding at such variance with normal as to be life-threatening if something is not done quickly, and for which there is a corrective action that can be taken.
We determined that it was the laboratory’s responsibility to recognize such a value and, after validation of the finding, to notify a clinician who will take responsibility for the result and initiate corrective action.
We created this system after the tragic death of a young patient whose serum glucose was 6 mg%, but who was treated as a neurosurgical case even though the test result was faxed to the ward within 2 hours, but went unnoted by the clinical staff.
We created a “Patient-Focused Critical Value Committee” that decided which tests and which values should be included in the original system. Initially this list included only 15 tests.
Full implementation became one of the first, fully operational, American “patient safety” fixes. We always believed that each individual medical staff should create its own list and values because, frankly, some clinicians and institutions have a lower threshold for pushing the panic button than do others.
I published this concept in March, 1972 in the Medical Laboratory Observer, a widely circulated “throwaway” of the time.
The article included a colorful centerfold pull-out chart. Within weeks, that chart was posted on hundreds of lab bulletin boards and the process became widely adopted. Soon, both the CAP and the JCAH made such a system mandatory and the future course for Critical Value reporting was established as a standard of practice.
What I want to learn from you is, how is the Critical Value reporting system working in your environment?
Is it still truly life-saving? Has it become such a part of routine application as to be simply an accepted part of culture? Do the current ubiquitous lab computers handle the reporting seamlessly?
Or, are you troubled by being notified of “critical values” that you already know about or that you think are not critical?
What now happens in the ambulatory care environment?
Let us know whether something more needs to be done about Critical Lab Values.
George Lundberg is a MedPage Today Editor-at-Large and former editor of the Journal of the American Medical Association.