<%@LANGUAGE="VBSCRIPT" CODEPAGE="1252"%> MGH Lab Handbook - Critical Values List
  MGH CLINICAL LABORATORY CALLBACK LIST      
 
 

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.

Critical test results will be communicated to the responsible licensed caregiver within 40 minutes from the time the result is available in the laboratory.

The 40 minute turnaround time is divided into:

  • 30 minutes for the Laboratory turnaround time (time from when the test result is identified as critical to the time when the floor/practice receives the result).
  • 10 minutes for the floor/practice turnaround time (time from when the floor/practice receives the result to the time when the result is communicated to the responsible licensed caregiver).

The laboratory in collaboration with the department or service involved in the monitor shall 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.

Approved by the MGH Medical Policy Committee: 06/2013

 
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 <1.0 or >4.9 mEq/L 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 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
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

-Platelets <40,000/cmm (critical)
-Hematocrit <20% or >56% (critical)
-WBC <1,500 or >50,000/cmm (critical)

Critical
  Differential Presence of blasts Critical
  Glucose <40 or >500 mg/dl Critical
  Magnesium <1.0 or >4.9 mEq/L 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

 

     
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This page last updated on November 27, 2013