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 |
