Massachusetts General Hospital

MGH Clinical Laboratory Critical Value 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 a licensed caregiver within 30 minutes from the time the result is available in the laboratory.   Critical values that are reported to a non-licensed caregiver will be communicated to a licensed caregiver as rapidly as possible.

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
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:
Current HCT between 20- 56% with a decrease of >20% of current value
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
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 Initial Positive or if pervious positive >3 months Courtesy
Aerobic Actinomycetes (Nocardia, etc) from culture Positive Courtesy
Antimicrobial Susceptibility Testing (AST) Meropenem or imipenem-resistant Enterobacteriaceae Linezolid-resistant Staph. aureus Vancomycin-resistant Staph. aureus Drug-resistant mycobacteria Courtesy
Beta Strep Throat Culture Positive for beta-hemolytic group A streptococcus Courtesy
Blood, CSF and Pericardial fluid cultures Positive for bacteria, fungi, yeast or acid-fast organisms Critical
C. difficile toxin and/or PCR test Positive Courtesy
Cryptococcal antigen tests (CSF) Positive Critical
Cryptococcal (non-CSF) 1st Positive Result is a CRITICAL Subsequent Positive Results Courtesy
CSF non-STAT Gram Stains Positive Critical
Fungal wet prep (non-CSF samples) Positive for mycelial elements (hyphae), or structures suggestive of dimorphic fungi such as spherules (s/o Coccidioides) or large yeast with broad-based budding (s/o Blastomyces) Courtesy
Fungal wet prep on CSF Positive Critical
Fungal Culture (non CSF) Zygomycetes molds, all Crytococcus neoformans and dimorphic fungi. Courtesy
GC/Chlamydia tests Positive Courtesy
Gram Stains Result of all STAT requests Critical
HSV PCR (CSF) Positive Critical
Influenza A/B PCR All positives Courtesy
Mycobacterial culture Positive for mycobacteria Courtesy
Mycobacterium tuberculosis PCR Positive Courtesy
Parasitology exams Positive Babesia, PCP and Malaria Smear Courtesy
Rapid Malaria Positive Critical
RSV PCR All positives Courtesy
Shiga Toxin Positives Courtesy
VDRL on CSF Positive Courtesy
Virology DFA tests (Adeno, Para, hMPV, HSV & VZV) All positives and inadequate specimens from inpatient units or Emergency Room Courtesy
Enterovirus (CSF) PCR Positive Courtesy
Norovirus PCR Positive 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