The list below includes Critical Callbacks and Courtesy Callbacks/E-mails.
Critical results are defined as results that, if left untreated, could be life threatening or place the patient at serious risk. Critical results are those results from a clinical specimen that upon analysis are determined to be "critical" whether the specimen was submitted as a routine or stat specimen.
The laboratory in collaboration with the department or service involved in the monitor will monitor the time between the identification of a critical value to the time it is reported to a licensed caregiver. Ongoing organizational efforts will target improvement in the timeliness of critical value reporting.
Courtesy callbacks/E-mails are made in accordance with individual laboratory policy in an effort to improve clinical communication.
Laboratory |
Test |
Value |
Critical or Courtesy |
Blood gas |
All blood gas tests from a non-cardiac OR |
All values |
Courtesy |
|
Calcium, ionized |
<0.8 or >1.54 mmol/L |
Critical |
|
Hemoglobin |
<6.5 g/dl |
Critical |
|
PCO2 (arterial, venous, unknown) |
<20 or >75 mmHg, first only (within past 24 hours) |
Critical |
|
pH (arterial, venous, unknown) |
<7.10 or >7.59 units, first only (within past 24 hours) |
Critical |
|
PO2 (arterial, unknown) |
<40 mmHg |
Critical |
Chemistry |
Acetaminophen |
>50 mg/L |
Critical |
|
Bilirubin, total |
>15 mg/dL (0-3 mo)
>20 mg/dL (4-6 mo) |
Critical |
|
Calcium |
<6.5 or >14.0 mg/dl |
Critical |
|
Carbamazepine |
>20 mcg/ml |
Critical |
|
Carbon dioxide (total) |
<11 or >40 mmol/L |
Critical |
|
Digoxin |
>2.5 ng/ml |
Critical |
|
Gentamicin |
Peak/Unknown: >9.9 ug/ml; Trough: > 2.9 ug/ml |
Critical |
|
Glucose, CSF |
<40 mg/dl |
Critical |
|
Glucose, plasma |
<40 or >500 mg/dl. [NOTE: For results <40 mg/dl for OUTPATIENTS, when practice is closed communication may be deferred until a time when practice is open, in recognition of the non-emergent nature of this result for an outpatient.] |
Critical |
|
Glucose, plasma |
All results from Blake 13 |
Courtesy |
|
Isopropanol |
>100 mg/L |
Critical |
|
Lithium |
>1.8 mmol/L |
Critical |
|
Magnesium |
<1.2 or >5.9 mg/dl |
Critical |
|
Methanol |
>100 mg/L |
Critical |
|
Osmolality, plasma or serum |
<250 or >335 mOsm/kg water |
Critical |
|
Phenobarbital |
>70 mcg/ml |
Critical |
|
Phenytoin |
>30 mcg/ml |
Critical |
|
Phosphorus |
<1.1 mg/dl |
Critical |
|
Potassium |
<2.8 or >6.0 mmol/L |
Critical |
|
Sodium |
<120 or >160 mmol/L |
Critical |
|
Tobramycin |
Peak/Unknown: >9.9 ug/ml; Trough: > 2.9 ug/ml |
Critical |
|
Toxicology (serum) |
Various toxic drug levels |
Courtesy |
|
Vancomycin |
Peak/Unknown: >39.9 ug/ml; Trough: > 39.9 ug/ml |
Critical |
Hematology |
Initial hematocrit |
>56% within 30 days (ages 1 month and above) |
Critical |
|
Delta values |
WITHIN THE LAST 30 DAYS:
Hematocrit >25% and decrease of ≥8% (outpatients only)
Hematocrit >20 and ≤25% and decrease of ≥4% (outpatients only)
Platelets <50 and decrease is equal to or >50% |
Courtesy |
|
Differential |
Presence of blasts on initial smear within 30 days |
Critical |
|
Initial hematocrit |
< or = to 20% within 30 days |
Critical |
|
Initial platelet count |
<40,000 or >999,000 within 30 days |
Critical |
|
Initial WBC |
<1,500 or >50,000 within 30 days |
Critical |
|
INR |
INR > or = to 5.0 |
Critical |
|
Partial thromboplastin time |
>100 seconds |
Critical |
|
Platelets |
All pediatric patients <20 years old with a platelet count of <20,000 |
Critical |
| |
Differential |
All pediatric patients <20 years old with the presence of blasts on peripheral blood smear |
Critical |
|
Differential |
Presence of “others” (other cells) on initial smear within 30 days
(Applies to Emergency Department testing only) |
Critical |
Immunology |
Cryocrit |
5% or higher |
Courtesy |
|
IgA |
<7 mg/dL |
Courtesy |
|
IgG |
<200 mg/dL |
Courtesy |
|
Viscosity |
>3 relative viscosity units |
Critical |
Microbiology |
Acid-fast smears |
All positives |
Courtesy |
|
Blood and CSF cultures |
Cultures positive for bacteria, fungi, yeast or acid-fast organisms |
Critical |
|
Cryptococcal and bacterial antigen tests |
Positive |
Courtesy |
|
Cultures |
Positive for mycobacteria |
Courtesy |
|
Cultures and direct FA |
Positive for Legionella |
Courtesy |
|
Fungal wet prep |
Positive for mycelial elements |
Courtesy |
|
Gram Stains |
All stat requests |
Critical |
|
Heterophile (inpatients only) |
Positive |
Courtesy |
|
Parasitology exams |
All pathogenic positives |
Courtesy |
|
Stool cultures |
Cultures positive for enteric pathogens |
Courtesy |
|
Syphilis serology (Inpatients only) |
High titer positive |
Courtesy |
|
Throat cultures |
Cultures positive for group A beta strep |
Courtesy |
|
VDRL on CSF |
Positive |
Courtesy |
|
Virology cultures, viral antigen tests, and viral PCR on CSF |
All positives |
Courtesy |
Chelsea Health Center |
Bilirubin, total |
>15 mg/dL (0-3 mo)
>20 mg/dL (4-6 mo) |
Critical |
|
Calcium |
<6.5 or >14.0 mg/dl |
Critical |
|
Carbon dioxide (total) |
<11 or >40 mmol/L |
Critical |
|
CBC |
Within the last 30 days:
-Platelets <40,000
-Hematocrit <20%
-Hematocrit >56% (ages 1 month and above)
-WBC <1,500 or >50,000 |
Critical |
|
Differential |
Presence of blasts |
Critical |
|
Glucose |
<40 or >500 mg/dl |
Critical |
|
Magnesium |
<1.2 or >5.9 mg/dl |
Critical |
|
Phosphorus |
<1.1 mg/dL |
Critical |
|
Potassium |
<2.8 or >6.0 mmol/L |
Critical |
|
Sodium |
<120 or >160 mmol/L |
Critical |
Revere Health Center |
Stool guaiac |
Positive |
Courtesy |
|
Whole blood glucose |
<40 or >500 mg/dl |
Critical |
Mass General Waltham |
|
|
|
|
Bilirubin, total |
>15 mg/dL (0-3 mo)
>20 mg/dL (4-6 mo) |
Critical |
|
Calcium |
<6.5 or >14.0 mg/dl |
Critical |
|
Carbon dioxide (total) |
<11 or >40 mmol/L |
Critical |
|
Glucose |
<40 or >500 mg/dl |
Critical |
|
Magnesium |
<1.2 or >5.9 mg/dl |
Critical |
|
Phosphorus |
<1.1 mg/dL |
Critical |
|
Potassium |
<2.8 or >6.0 mmol/L |
Critical |
|
Sodium |
<120 or >160 mmol/L |
Critical |
|
Initial hematocrit |
>56% within 30 days (ages 1 month and above) |
Critical |
|
Delta values |
WITHIN THE LAST 30 DAYS:
Hematocrit >25% and decrease of =8% (outpatients only)
Hematocrit >20 and =25% and decrease of =4% (outpatients only)
Platelets <50 and decrease is equal to or >50% |
Courtesy |
|
Differential |
Presence of blasts on initial smear within 30 days |
Critical |
|
Initial hematocrit |
< or = to 20% within 30 days |
Critical |
|
Initial platelet count |
<40,000 or >999,000 within 30 days |
Critical |
|
Initial WBC |
<1,500 or >50,000 within 30 days |
Critical |
|
INR |
INR > or = to 5.0 |
Critical |
|
Partial thromboplastin time |
>120 seconds |
Critical |
|
Platelets |
All pediatric patients <20 years old with a platelet count of <20,000 |
Critical |
|
Differential |
All pediatric patients <20 years old with the presence of blasts on peripheral blood smear |
Critical |
