Calling Critical Values

[jojo808]

Let me start with an example: Oncology patient is admitted and has a critical WBC of 1.0 I'm going to assume everyone has to call the floors with this value. Now my real question is if the patient has a CBC Q6H how many of you have to keep calling the critical value. Is it not necessary in your hospital to call subsequent critical WBC values? Same for other critical values? Any other scenario can be used, and thank you in advance for any response. 

[John C. Staley]

We found that certain specialties were not interested in our standard critical values and instituted their own for their patients.  Not a big deal because there were not many.  One in particular was Oncology.  I don't remember their values but I do remember they were considerably lower than our standard critical values.  They also indicated that they only wanted follow up notification if the values dropped significantly and they told us what a significant drop was.  I'm sure you are aware that critical values is not a "one size fits all" and it is a case where flexibility can be your friend.  Talk with them or better yet have your medical director talk with them and see what they would work best for them.  I found over the years that a doctor to doctor conversation was often much more productive.  Of course that assumes your medical director is willing to go to bat for you.

[Neil Blumberg]

Once you've called a critical value of something that doesn't change rapidly, like a very low platelet, red cell or white cell count, you don't need to keep calling every subsequent value, since the ordering physician/NP/PA has the responsibility of checking lab values for studies they order.  Not the lab.  Plus it's a waste of everyone's time and annoying :).

Not a big fan of critical values in general, particularly for non-emergent metrics like cell counts, creatinine, BUN, etc.  Usually the clinical situation is vastly more important than any laboratory number, including for the CBC and chemistries other than electrolytes.  One of the big time wasters in laboratory and clinical medicine.  Only unexpected values that need action within minutes to hours need to be "critical" and called in my view.  Blood cell counts aren't among them in my view.  There's nothing critical about a white cell count of 500 or 100.  Presence of blasts is another story.