Reaching consensus on communication of critical laboratory results using a collective intelligence method
-
Maria Isabel Llovet
,
Carmen Biosca
Abstract
Background:
There is no consensus in the literature about what analytes or values should be informed as critical results and how they should be communicated. The main aim of this project is to establish consensual standards of critical results for the laboratories participating in the study. Among the project’s secondary objectives, establishing consensual procedures for communication can be highlighted.
Methods:
Consensus was reached among all participating laboratories establishing the basis for the construction of the initial model put forward for consensus in conjunction with the clinicians. A real-time Delphi, methodology “health consensus” (HC), with motivating and participative questions was applied. The physician was expected to choose a numeric value within a scale designed for each analyte.
Results:
The medians of critical results obtained represent the consensus on critical results for outpatient and inpatient care. Both in primary care and in hospital care a high degree of consensus was observed for critical values proposed in the analysis of creatinine, digoxin, phosphorus, glucose, international normalized ratio (INR), leukocytes, magnesium, neutrophils, chloride, sodium, calcium and lithium. For the rest of critical results the degree of consensus obtained was “medium high”. The results obtained showed that in 72% of cases the consensual critical value coincided with the medians initially proposed by the laboratories.
Conclusions:
The real-time Delphi has allowed obtaining consensual standards for communication of critical results among the laboratories participating in the study, which can serve as a basis for other organizations.
Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.
Research funding: IDIAP JORDI GOL Institut Catala de la Salut, 17 aid to research projects in primary health care.
Employment or leadership: None declared.
Honorarium: None declared.
Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.
References
1. Lundberg G. When to panic over an abnormal value. Med Lab Obs 1972;4:47–54.Search in Google Scholar
2. International Organization for Standardization (ISO). ISO 15189:2012: medical laboratories. Requirements for quality and competence. Geneva: ISO.Search in Google Scholar
3. Joint Commission on Accreditation of Healthcare Organization (JCAHO); Laboratory Services: National Patient Safety Goals. 2013. http://www.jointcommission.org.Search in Google Scholar
4. Hashim IA, Cuthbert JA. Establishing, harmonizing and analyzing critical values in a large academic health center. Clin Chem Lab Med 2014;52:1129–35.10.1515/cclm-2014-0029Search in Google Scholar PubMed
5. Campbell CA, Horvath AR. Harmonization of critical result management in laboratory medicine. Clin Chim Acta 2014;432:135–47.10.1016/j.cca.2013.11.004Search in Google Scholar PubMed
6. Piva E, Plebani M. From “panic” to “critical” values: which path toward harmonization? Clin Chem Lab Med 2013;51:2069–71.10.1515/cclm-2013-0459Search in Google Scholar PubMed
7. Campbell CA, Georgiou A, Westbrook JI, Horvath AR. What alert thresholds should be used to identify critical risk results: a systematic review of the evidence. Clin Chem Lab Med 2016;62:1–13.10.1373/clinchem.2016.260638Search in Google Scholar PubMed
8. Lam Q, Ajzner E, Campbell CA, Young A. Critical risk results-and updated on international initiatives. EJIFCC 2016;27:66–76.Search in Google Scholar
9. Kost GJ, Hale KN. Global trends in critical values practices and their harmonization. Clin Chem Lab Med 2011;49:167–76.10.1515/CCLM.2011.033Search in Google Scholar PubMed
10. Kopcinovic LM, Trifunovic J, Pavosevic T, Nikolac N. Croatian survey on critical results reporting. Biochem Med 2015;25:193–202.10.11613/BM.2015.019Search in Google Scholar PubMed PubMed Central
11. Don-Wauchope AC, Chetty VT. Laboratory defined critical value limits: how do hospital physicians perceive laboratory based critical values. Clin Biochem 2009;42:766–70.10.1016/j.clinbiochem.2009.02.016Search in Google Scholar PubMed
12. Sikaris K. Performance criteria of the post-analytical phase. Clin Chem Lab Med 2015;53:949–58.10.1515/cclm-2015-0016Search in Google Scholar PubMed
13. Clinical and Laboratory Standard Institute (CLSI); Management of Critical- and Significant- Risk Results (GP47-Ed1). 2015. http://clsi.org.Search in Google Scholar
14. Monguet JM, Gutiérrez A, Ferruzca M, Alatriste Y, Martínez C, Córdoba C, et al. Vector consensus model. In: Quintela-Alves JE, Cruz-Cunha MM, editors. Organizational integration of enterprise systems and resources: advancements and applications. IGI Global, 2012:303–17.10.4018/978-1-4666-1764-3.ch017Search in Google Scholar
15. Phillips AC, Lewis LK, McEvoy MP, Galipeau J, Glasziou P, Hammick M, et al. A Delphi survey to determine how educational interventions for evidence-based practice should be reported: stage 2 of the development of a reporting guideline. BMC Med Educ 2014;14:159.10.1186/1472-6920-14-159Search in Google Scholar PubMed PubMed Central
16. Martí T, Monguet JM, Trejo A, Escarrabill J, Constante C. June 2014. Available from: http://upcommons.upc.edu/handle/2117/24737 (Collective Intelligence Conference 2014).Search in Google Scholar
17. Martí T, Monguet JM, Trejo A, Escarrabill J. June 2015. Available from: http://sites.lsa.umich.edu/wp-content/uploads/sites/176/2015/02/ (Collective Intelligence Conference 2015).Search in Google Scholar
18. Monguet JM, Trejo A, Martí T, Espallargues M, Serra-Sutton V, Escarrabill J. Assessment of chronic health care through an internet consensus tool. In: Dimitrios IF, editor. Handbook of research on trends in the diagnosis and treatment of chronic conditions. Hershey, Pennsylvania: IGI Global, 2015:424–43.Search in Google Scholar
19. López-Pelayo I, Fernández A, Romero De Castilla RJ, Zambrana JL. Clinical impact of laboratory critical values notification as a tool for patient safety [In Spanish]. Med Clin 2012;139:221–6.10.1016/j.medcli.2012.01.026Search in Google Scholar PubMed
20. Doering TA, Plapp F, Crawford JM. Establishing an evidence base for critical laboratory value thresholds. Am J Clin Pathol 2014;142:617–28.10.1309/AJCPDI0FYZ4UNWEQSearch in Google Scholar PubMed
21. Saw S, Loh TP, Ang SB, Yip JW, Sethi SK. Meeting regulatory requirements by the use of cell phone text message notification with autoescalation and loop closure for reporting of critical laboratory results. Am J Clin Pathol 2011;136:30–4.10.1309/AJCPUZ53XZWQFYISSearch in Google Scholar PubMed
22. Lippi G, Giaverina D, Montagnana M, Salvagno GL, Cappelleti GC, Plebani M, et al. National survey on critical values reporting in a cohort of italian laboratories. Clin Chem Lab med 2007;45:1411–3.10.1515/CCLM.2007.288Search in Google Scholar PubMed
23. Llopis MA, Gomez R, Alvarez V, Martinez C, Cortes M, Barba N, et al. Critical values reporting: results of a Spanish laboratorios survey [In Spanish]. Rev Lab Clin 2010;3:177–82.Search in Google Scholar
24. Campbell CA, Horvath AR. Toward harmonisation of critical laboratory result management-review of the literature and survey of Australasian practices. Clin Biochem Rev 2012;334:149–60.Search in Google Scholar
25. Longtin Y, Sax H, Leape LL, Sheridan SE, Donaldson L, Pittet D. Patient participation: current knowledge and applicability to patient safety. Mayo Clin Proc 2010;85:53–62.10.4065/mcp.2009.0248Search in Google Scholar PubMed PubMed Central
Supplemental Material:
The online version of this article offers supplementary material (https://doi.org/10.1515/cclm-2017-0374).
©2018 Walter de Gruyter GmbH, Berlin/Boston
Articles in the same Issue
- Frontmatter
- Editorial
- Analytical quality: an unfinished journey
- Reviews
- Update in diagnosis and management of primary aldosteronism
- Diagnosis biomarkers in acute intestinal ischemic injury: so close, yet so far
- Opinion Papers
- Irregular analytical errors in diagnostic testing – a novel concept
- A Black Swan in clinical laboratory practice: the analytical error due to interferences in immunoassay methods
- General Clinical Chemistry and Laboratory Medicine
- Reaching consensus on communication of critical laboratory results using a collective intelligence method
- Stability of routine biochemical analytes in whole blood and plasma/serum: focus on potassium stability from lithium heparin
- GFR estimation based on standardized creatinine and cystatin C: a European multicenter analysis in older adults
- Binding of bromocresol green and bromocresol purple to albumin in hemodialysis patients
- Interlaboratory variability of urinary iodine measurements
- The venous thromboembolic risk and the clot wave analysis: a useful relationship?
- Hematology and Coagulation
- Autovalidation and automation of the postanalytical phase of routine hematology and coagulation analyses in a university hospital laboratory
- Reference Values and Biological Variations
- Indirect method for validating transference of reference intervals
- Differences in levels of albumin, ALT, AST, γ-GT and creatinine in frail, moderately healthy and healthy elderly individuals
- Cancer Diagnostics
- Serum exosomal hnRNPH1 mRNA as a novel marker for hepatocellular carcinoma
- Intragenic hypomethylation of DNMT3A in patients with myelodysplastic syndrome
- Cardiovascular Diseases
- Evaluation of analytical performance of a new high-sensitivity immunoassay for cardiac troponin I
- MEF2C loss-of-function mutation associated with familial dilated cardiomyopathy
- Letter to the Editor
- Hyperuricemia does not seem to be an independent risk factor for coronary heart disease
- Reply to: Hyperuricemia does not seem to be an independent risk factor for coronary heart disease
- Preanalytics of ammonia: stability, transport and temperature of centrifugation
- Influence of delayed separation of plasma from whole blood on Cu, I, Mn, Se, and Zn plasma concentrations
- Copeptin as a diagnostic and prognostic biomarker in patients admitted to Emergency Department with syncope, presyncope and vertiginous syndrome
- Development of an internally controlled quantitative PCR to measure total cell-associated HIV-1 DNA in blood
- Selective changes in cholesterol metabolite levels in plasma of breast cancer patients after tumor removal
- Athletes beware before throwing towels to audiences
Articles in the same Issue
- Frontmatter
- Editorial
- Analytical quality: an unfinished journey
- Reviews
- Update in diagnosis and management of primary aldosteronism
- Diagnosis biomarkers in acute intestinal ischemic injury: so close, yet so far
- Opinion Papers
- Irregular analytical errors in diagnostic testing – a novel concept
- A Black Swan in clinical laboratory practice: the analytical error due to interferences in immunoassay methods
- General Clinical Chemistry and Laboratory Medicine
- Reaching consensus on communication of critical laboratory results using a collective intelligence method
- Stability of routine biochemical analytes in whole blood and plasma/serum: focus on potassium stability from lithium heparin
- GFR estimation based on standardized creatinine and cystatin C: a European multicenter analysis in older adults
- Binding of bromocresol green and bromocresol purple to albumin in hemodialysis patients
- Interlaboratory variability of urinary iodine measurements
- The venous thromboembolic risk and the clot wave analysis: a useful relationship?
- Hematology and Coagulation
- Autovalidation and automation of the postanalytical phase of routine hematology and coagulation analyses in a university hospital laboratory
- Reference Values and Biological Variations
- Indirect method for validating transference of reference intervals
- Differences in levels of albumin, ALT, AST, γ-GT and creatinine in frail, moderately healthy and healthy elderly individuals
- Cancer Diagnostics
- Serum exosomal hnRNPH1 mRNA as a novel marker for hepatocellular carcinoma
- Intragenic hypomethylation of DNMT3A in patients with myelodysplastic syndrome
- Cardiovascular Diseases
- Evaluation of analytical performance of a new high-sensitivity immunoassay for cardiac troponin I
- MEF2C loss-of-function mutation associated with familial dilated cardiomyopathy
- Letter to the Editor
- Hyperuricemia does not seem to be an independent risk factor for coronary heart disease
- Reply to: Hyperuricemia does not seem to be an independent risk factor for coronary heart disease
- Preanalytics of ammonia: stability, transport and temperature of centrifugation
- Influence of delayed separation of plasma from whole blood on Cu, I, Mn, Se, and Zn plasma concentrations
- Copeptin as a diagnostic and prognostic biomarker in patients admitted to Emergency Department with syncope, presyncope and vertiginous syndrome
- Development of an internally controlled quantitative PCR to measure total cell-associated HIV-1 DNA in blood
- Selective changes in cholesterol metabolite levels in plasma of breast cancer patients after tumor removal
- Athletes beware before throwing towels to audiences
