Home National survey on critical values notification of 599 institutions in China
Article
Licensed
Unlicensed Requires Authentication

National survey on critical values notification of 599 institutions in China

  • Rong Zeng , Wei Wang and Zhiguo Wang EMAIL logo
Published/Copyright: July 10, 2013
Become an author with De Gruyter Brill
Submit Manuscript Author Information
Clinical Chemistry and Laboratory Medicine (CCLM)
From the journal Clinical Chemistry and Laboratory Medicine (CCLM) Volume 51 Issue 11

Abstract

Background: A national cross-sectional survey on the reporting of critical values was conducted to provide suggestions on monitoring of the quality indicator and obtain the goal of quality improvement.

Methods: All clinical laboratories participating in the external quality assessment (EQA) programs of chemistry, blood gas, and hematology tests organized by the National Center for Clinical Laboratories (NCCL) were enrolled in our study. General information on the policy of critical values reporting and the particular problems about critical limits and practice of critical values reporting in the last 2 months were asked in the questionnaire. All collected data were analyzed by the special statistical software designed by the NCCL.

Results: The return rate of surveys for critical values on clinical biochemistry, blood gas, and hematology testing were 46.11%, 41.14%, and 39.42%, respectively. Most laboratories in the surveys suggested they set different critical limits for children and adults. The analytes of critical values chosen most frequently were potassium, glucose, sodium, calcium, pH, pCO2, pO2, white blood cell (WBC) count, hemoglobin (Hb), prothrombin time (PT), activated partial thromboplastin time, and fibrinogen. The analytes with most critical values were potassium, blood gas, and creatinine for clinical biochemistry, pCO2 for blood gas, and WBC, Hb, and PT for hematology testing. The medians of critical limits for potassium, sodium, calcium, and glucose were not significantly different from the results of the national survey conducted by Kost in 1990.

Conclusions: Remarkable inter-laboratory difference in the development and implementation of critical values reporting procedure were found. Laboratories should communicate with clinicians to obtain consensus on the analytes and limits of critical values.

Keywords: critical values; external quality assessment (EQA); post-analytical; quality indicators
Corresponding author: Professor Zhiguo Wang, National Center for Clinical Laboratories, Beijing Hospital of the Ministry of Health, No. 1, Dahua Road, Dongdan, Dongcheng District, Beijing 100730, P.R. China, Phone: +86-10-58115054, Fax: +86-10-65273025, E-mail:

References

1. Lundberg GD. When to panic over abnormal values. MLO Med Lab Obs 1972;4:47–54.Search in Google Scholar

2. Kost GJ. Critical limits for urgent clinician notification at US medical centers. J Am Med Assoc 1990;263:704–7.10.1001/jama.1990.03440050098042Search in Google Scholar

3. Available from:http://www.jointcommission.org/assets/1/18/NPSG_Chapter_Jan2013_HAP.pdf.Search in Google Scholar

4. Centers for Medicare and Medicaid Services, Department of Health and Human Services. Part 493. Laboratory requirements: Clinical Laboratory Improvement Amendments of l988 Code of Federal Regulations, Title 42. Parts 430 to end. US Government Printing Office, published annually.Search in Google Scholar

5. ISO. Medical laboratories: particular requirements for quality and competence. ISO 15189. Geneva: International Organization for Standardization, 2007.Search in Google Scholar

6. Department of Medical Administration, Ministry of Health of the People’s Republic of China. Patients safety goals for 2009 and 2010. Beijing, China: Science Press, 2009:6.Search in Google Scholar

7. Department of Medical Administration, Ministry of Health of the People’s Republic of China. Hospital management evaluation guideline and the evaluation standards for general hospitals. Beijing, China: Science Press, 2009.Search in Google Scholar

8. Valenstein PN, Wagar EA, Stankovic AK, Walsh MK, Schneider F. Notification of critical results: a College of American Pathologists Q-probes study of 121 institutions. Arch Pathol Lab Med 2008;132:1862–7.10.5858/132.12.1862Search in Google Scholar PubMed

9. Lippi G, Giavarina D, Montagnana M, Luca SG, Cappelletti P, Plebani M, et al. National survey of critical values and reporting in a cohort of Italian laboratories. Clin Chem Lab Med 2007;45:1411–3.http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=000250943800024&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=b7bc2757938ac7a7a821505f8243d9f3Search in Google Scholar

10. Wagar EA, Friedberg RC, Souers R, Stankovic AK. Critical values comparison: a College of American Pathologists Q-probes survey of 163 clinical laboratories. Arch Pathol Lab Med 2007;131:1769–75.10.5858/2007-131-1769-CVCACOSearch in Google Scholar PubMed

11. Piva E, Sciacovelli L, Laposata M, Plebani M. Assessment of critical values policies in Italian institutions: comparison with the US situation. Clin Chem Lab Med 2010;48: 461–8.http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=000275786200005&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=b7bc2757938ac7a7a821505f8243d9f3Search in Google Scholar PubMed

12. Toll AD, Liu JM, Gulati G, Behling EM, Kocher WD. Does routine repeat testing of critical values offer any advantage over single testing? Arch Pathol Lab Med 2011;135:440–4.10.5858/2010-0025-OA.1Search in Google Scholar PubMed

13. Howanitz PJ, Steindel SJ, Heard NV. Laboratory critical values policies and procedures: a College of American Pathologists Q-probes study in 623 institutions. Arch Pathol Lab Med 2002;126:663–9.10.5858/2002-126-0663-LCVPAPSearch in Google Scholar PubMed

14. Kost GJ, Hale KN. Global trends in critical values practices and their harmonization. Clin Chem Lab Med 2011;49:167–76.http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=000287855900002&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=b7bc2757938ac7a7a821505f8243d9f310.1515/CCLM.2011.033Search in Google Scholar PubMed

15. Table of critical limits. MLO Supplement, August 2007, 6–7.Search in Google Scholar

16. Kost GJ. Critical limits for emergency clinician notification at United States children’s hospitals. Pediatrics 1992;8:597–603.10.1542/peds.88.3.597Search in Google Scholar
Received: 2013-03-11
Accepted: 2013-06-15
Published Online: 2013-07-10
Published in Print: 2013-11-01

©2013 by Walter de Gruyter Berlin Boston

Articles in the same Issue

  1. Letter to the Editor
  2. Elevated level of cell-free plasma DNA is associated with advanced-stage breast cancer and metastasis
  3. Is procalcitonin a reliable marker of sepsis in critically ill septic patients undergoing continuous veno-venous hemodiafiltration with “high cut-off” membranes (HCO-CVVHDF)?
  4. Challenging our serological algorithm for celiac disease (CD) diagnosis by the ESPGHAN guidelines
  5. Preanalytical quality control in a university hospital in China
  6. Racial differences and relationships between gestational thyrotropin and free thyroxine in a multiracial Asian population
  7. Analytical performance and method comparison study of the total homocysteine immunoassay on the AIA 600II analyser
  8. Easy verification of clinical chemistry reference intervals
  9. The Elecsys® Vitamin B12 assay is not affected by anti-intrinsic factor antibodies
  10. Chemiluminescence-based cobalamin assay errors: background and perspectives
  11. Congress Abstracts
  12. Abstracts IV Italian Great Network Congress Rome, 14th–18th October 2013*)
  13. Masthead
  14. Masthead
  15. Editorial
  16. Making colorectal cancer screening FITTER for purpose with quantitative faecal immunochemical tests for haemoglobin (FIT)
  17. From “panic” to “critical” values: which path toward harmonization?
  18. Review
  19. Cerebrospinal fluid analyses for the diagnosis of subarachnoid haemorrhage and experience from a Swedish study. What method is preferable when diagnosing a subarachnoid haemorrhage?
  20. Opinion Paper
  21. False myths and legends in laboratory diagnostics
  22. General Clinical Chemistry and Laboratory Medicine
  23. National survey on critical values notification of 599 institutions in China
  24. Influence of physical properties of cuvette surface on measurement of serum lipase
  25. Red cell indices: differentiation between β-thalassemia trait and iron deficiency anemia and application to sickle-cell disease and sickle-cell thalassemia
  26. Measurement of immature platelets with Abbott CD-Sapphire and Sysmex XE-5000 in haematology and oncology patients
  27. Performance characteristics of consensus approaches for small and minor paroxysmal nocturnal hemoglobinuria clone determination by flow cytometry
  28. Comparison of PR3-ANCA specific assay performance for the diagnosis of granulomatosis with polyangiitis (Wegener’s)
  29. The integration of the detection of systemic sclerosis-associated antibodies in a routine laboratory setting: comparison of different strategies
  30. Reference Values and Biological Variations
  31. Reference interval studies: what is the maximum number of samples recommended?
  32. Short-term estimation and application of biological variation of small dense low-density lipoproteins in healthy individuals
  33. Cancer Diagnostics
  34. Diagnostic inconsistency of faecal immunochemical tests for haemoglobin in population screening of colorectal cancer
  35. Cardiovascular Diseases
  36. Comparison of the 99th percentiles of three troponin I assays in a large reference population
  37. Assessment of plasma aminothiol levels and the association with recurrent atherothrombotic events in patients hospitalized for an acute coronary syndrome: a prospective study
  38. Diabetes
  39. The relationship between estimated average glucose and fasting plasma glucose
  40. Evaluation of enzymatic BM Test HbA1c on the JCA-BM6010/C and comparison with Bio-Rad Variant II Turbo, Tosoh HLC 723 G8, and AutoLab immunoturbidimetry assay
https://doi.org/10.1515/cclm-2013-0183
Keywords for this article
critical values; external quality assessment (EQA); post-analytical; quality indicators

Articles in the same Issue

  1. Letter to the Editor
  2. Elevated level of cell-free plasma DNA is associated with advanced-stage breast cancer and metastasis
  3. Is procalcitonin a reliable marker of sepsis in critically ill septic patients undergoing continuous veno-venous hemodiafiltration with “high cut-off” membranes (HCO-CVVHDF)?
  4. Challenging our serological algorithm for celiac disease (CD) diagnosis by the ESPGHAN guidelines
  5. Preanalytical quality control in a university hospital in China
  6. Racial differences and relationships between gestational thyrotropin and free thyroxine in a multiracial Asian population
  7. Analytical performance and method comparison study of the total homocysteine immunoassay on the AIA 600II analyser
  8. Easy verification of clinical chemistry reference intervals
  9. The Elecsys® Vitamin B12 assay is not affected by anti-intrinsic factor antibodies
  10. Chemiluminescence-based cobalamin assay errors: background and perspectives
  11. Congress Abstracts
  12. Abstracts IV Italian Great Network Congress Rome, 14th–18th October 2013*)
  13. Masthead
  14. Masthead
  15. Editorial
  16. Making colorectal cancer screening FITTER for purpose with quantitative faecal immunochemical tests for haemoglobin (FIT)
  17. From “panic” to “critical” values: which path toward harmonization?
  18. Review
  19. Cerebrospinal fluid analyses for the diagnosis of subarachnoid haemorrhage and experience from a Swedish study. What method is preferable when diagnosing a subarachnoid haemorrhage?
  20. Opinion Paper
  21. False myths and legends in laboratory diagnostics
  22. General Clinical Chemistry and Laboratory Medicine
  23. National survey on critical values notification of 599 institutions in China
  24. Influence of physical properties of cuvette surface on measurement of serum lipase
  25. Red cell indices: differentiation between β-thalassemia trait and iron deficiency anemia and application to sickle-cell disease and sickle-cell thalassemia
  26. Measurement of immature platelets with Abbott CD-Sapphire and Sysmex XE-5000 in haematology and oncology patients
  27. Performance characteristics of consensus approaches for small and minor paroxysmal nocturnal hemoglobinuria clone determination by flow cytometry
  28. Comparison of PR3-ANCA specific assay performance for the diagnosis of granulomatosis with polyangiitis (Wegener’s)
  29. The integration of the detection of systemic sclerosis-associated antibodies in a routine laboratory setting: comparison of different strategies
  30. Reference Values and Biological Variations
  31. Reference interval studies: what is the maximum number of samples recommended?
  32. Short-term estimation and application of biological variation of small dense low-density lipoproteins in healthy individuals
  33. Cancer Diagnostics
  34. Diagnostic inconsistency of faecal immunochemical tests for haemoglobin in population screening of colorectal cancer
  35. Cardiovascular Diseases
  36. Comparison of the 99th percentiles of three troponin I assays in a large reference population
  37. Assessment of plasma aminothiol levels and the association with recurrent atherothrombotic events in patients hospitalized for an acute coronary syndrome: a prospective study
  38. Diabetes
  39. The relationship between estimated average glucose and fasting plasma glucose
  40. Evaluation of enzymatic BM Test HbA1c on the JCA-BM6010/C and comparison with Bio-Rad Variant II Turbo, Tosoh HLC 723 G8, and AutoLab immunoturbidimetry assay
Sign up now to receive a 20% welcome discount
Institutional Access
How does access work?
Have an idea on how to improve our website?
Please write us.
© 2025 De Gruyter Brill
Downloaded on 27.9.2025 from https://www.degruyterbrill.com/document/doi/10.1515/cclm-2013-0183/html
Scroll to top button