LAXMI HEALTH CARE CENTRE AND HOSPITAL

Policy Title: Critical and Abnormal Value Reporting

Policy
Approval: Dr. Sandeep Maurya.

Dr. Chandkala Maurya

Last Review Date: April, 2025 Last Revised:April, 2026
Policy:
It is the policy of the Department of Pathology and Laboratory Medicine to report
critical values, which are those values that medical leadership has determined
indicate a potentially dangerous condition requiring attention by the health care
provider within one hour.

Results exceeding the following limits are identified by a “C” indicating critical
on the laboratory report and in all electronic systems.

Inpatient and outpatient results that exceed the following limits are called to the
appropriate location by the Laboratory staff, who will identify the result as
“Critical”. A chartable footnote will be added to the LIS patient record noting the
date and time of the call, and the name of the person taking the results. A
comment is also added that the receiver has read back the results to the caller.
Please refer to Policy #Policy - Critical Values, Add-On Orders, Read-Repeat
Back, and Clarification of Orders for guidelines on documenting read back.

Procedure:
The following procedure has been established to assist the laboratory staff with the
timely communication of critical values.
Critical Care Patient Care Services has defined who in the organization is
authorized to take critical values. This list includes nurses, respiratory therapists,
and unit clerks as well as physicians. Please refer to the Corporate Policy on
Critical Values for further information and the specific list of authorized
personnel.

I. Inpatient and 23 Hour Admitted Patients:

1. The Laboratory Scientist will call the Nursing location of the patient
as identified in the LI
2. S and state that they have a critical value to report on the patient.

pg. 1
 3. A chartable footnote will be added to the LIS patient record noting
the date and time of the call and the name of the person taking the
results. A comment is also added that the receiver has read back the
results to the caller.
4. If the receiver fails to read back the critical result, a Report to Learn
event should be generated.

II. Outpatient
1. The scientist will identify the ordering health care provider in the LIS.
2. The scientist will use the INet Communication tab for the Medical
Dental Staff Directory and enter the last name of the ordering
individual to obtain the phone number. An alternative is to utilize the
LIS to find the provider’s name and phone number.
3. A chartable footnote will be added to the LIS patient record noting
the date and time of the call and the name of the person taking the
results. A comment is also added that the receiver has read back the
results to the caller.
4. In the event a voice mail must be left, the message should request a
return call to ChristianaCare Laboratory to receive a critical value on
(patient name). The laboratory caregiver’s name, contact phone
number and time of call should be included in the message. The
caregiver will document the call.
a. If no return call is received within 15 minutes, another call
should be placed with all documentation noted. If no return call
has been received within 45 minutes of the original call and it is
during business hours (M-F 8a – 430p), contact the Chief
Pathologist for that laboratory section. In the absence of the
Section Chief, contact the Laboratory Medical Director. During
non-business hours (outside of M-F, 8a – 430p), contact the
Pathologist on call through Vocera, unless it is a critical
Hematology or Coagulation value, in which case contact the
Hematologist on call. The caregiver should be prepared to
provide the patient’s name, critical value, ordering physician
name, and physician’s phone number.
5. It is the laboratory caregiver’s responsibility to document all
activity and to “hand off” the open item, if leaving the area for any
reason. Notification of a critical value should not remain
unresolved beyond one hour without appropriate notification.
6. When the on-call pathologist or hematologist returns the call to the
laboratory with documentation of hand-off of the critical value to the
clinician, a chartable footnote will be added to the LIS patient
record noting the date and time of the call and the name of the
person taking the results.
 III. Critical Values
1. Clinical Chemistry
a. Routine Chemistry
Test Low High
Albumin <1.5 g/dL
Calcium, Total, Serum <6.0 mg/dL >12.5 mg/dL
Calcium, Ionized, Serum <0.75 mmol/L>1.50 mmol/L
Carbon Dioxide (CO2), Serum <10 mM/L >45 mmol/L
CK >20,000 IU/L ---
Glucose, Serum <40 mg/dL >400 mg/dL
Glucose (Newborn), Serum <40 mg/dL >400 mg/dL
HCO3 <10 mmol/L ---
Lactate, Plasma --- ≥4.0 mmol/L
Magnesium, Serum <1.0 mg/dL >4.8 mg/dL
pO2 Arterial <40 mm Hg ---
O2 Saturation, Arterial <70% ---
pH, Arterial/Venous <7.2 >7.6
Phosphorus, Inorganic, Serum <1.0 mg/dL ---
Potassium, Serum <2.8 mmol/L >6.2 mmol/L
Sodium, Serum <120 mmol/L >160 mmol/L
High Sensitivity (hs) Troponin I (adults ≥18 years) ≥64 ng/L
High Sensitivity (hs) Troponin I Delta (adults ≥18 ≥15 ng/L
years)
High Sensitivity (hs) Troponin I (Pediatrics <18 years) ≥20 ng/L
High Sensitivity (hs) Troponin I Delta (Pediatrics <18 ≥10 ng/L
years)
Direct Bilirubin (neonates <14 days) --- >1.0 mg/dL
Total/Neonatal Bilirubin
Specimen Age Critical Results (mg/dL)
Cord Blood 0 days > 3.0
Serum/plasma 0 days > 9.0
Serum/plasma 1 days > 12.0
Serum/plasma 2 days > 13.0
Serum/plasma 3 days > 16.0
Serum/plasma 4 days > 17.0
Serum/plasma 5 - 13 days > 18.0
Serum/plasma > 14 days None
 **hs Troponin T, hs Troponin T Delta and CK critical results are called only in
the first occurrence of the critical value and not subsequently**
2. Therapeutic Drug Levels
The following critical results are called to the appropriate location for
both inpatients and outpatients.
Test Critical Result
Acetaminophen (Tylenol®), Serum >150 mg/L
Caffeine, Serum ≥50 mg/L
Carbamazepine (Tegretol®), Serum >20 mg/L
Digoxin, Serum >2.5 mcg/L
Lithium, Serum >2.0 mmol/L
Methotrexate ≥5.0 µmol/L
Phenobarbital, Peak/Trough, Serum >60 mg/L
Phenytoin, Peak/Trough, Serum ≥30 mg/L
Salicylate, Serum >30 mg/dL
Theophylline, Serum (Neonatal) >15 mg/L
Theophylline (Adult) >25 mg/L
Valproic Acid >200 mg/L
Tacrolimus ≥20.0 ng/mL
Sirolimus ≥20.0 ng/mL

3. Hematology
Results exceeding the following limits are identified by a 'C' (Critical
Value) on the laboratory report and are called to the nursing unit or
outpatient location. Laboratory staff will identify the results as
“Critical” and follow the guidelines for documentation stated above.
Test Low High
INR ≥6.0
PTT (inpatient only) ≥150 seconds
HPTT (inpatient only) ≥150 seconds
Hemoglobin (Hgb) ≤6.0 g/dL
Platelets (1 time for current
st
≤20 ≥1,000
admission) X10E3/uL X10E3/uL
(≥ 4 months)
Platelets (everytime) ≤20 ≥1,000
(< 4 months) X10E3/uL X10E3/uL
WBC (1st time for current ≤1.0 ≥40.0
admission)** X10E3/uL X10E3/uL
 ANC (ED and Pediatric ED patients ≤0.5 X10E3/uL /nL
only)
Fibrinogen ≤100 mg/dL
Blood Parasites Positive
Factor Inhibitor ≥0.6 B.U.
Fetal Hgb ≥0.2%
a. For Hematology and Oncology patients these critical results
are called only on the first occurrence of the critical value and
not subsequently. Critical WBCs on patients in CBLB that have
the diagnosis of “stem cell” will not be called.
b. When calling critical results for WBC, HGB or PLT (including
delta HGBs) all three results, regardless of their value, must be
communicated to the floor when making the call.
Example: “I have a critical PLT result of 14 for patient John
Doe. The patient also has a WBC of 11.0 and a HGB of
12.3. Follow up with the clinician is recommended.”

4. Microbiology
The following critical inpatient results are called to the Nursing Unit
and outpatient results are called to the physician's office. Laboratory
staff will identify the results as “critical”.

See POLICY 05 Guidelines for Reporting Critical and Abnormal

[Link] for further information.

IV. Abnormal Values

The following results, although not considered “Critical” (requiring
physician notification within one hour of completion), require prompt
notification of a care provider so that an evaluation of the impact on the
patient can be determined. These are vital results that indicate
abnormalities which suggest prompt attention but not immediate response
by the health care provider. These results do not require a stat page.
These results will be called to the nursing unit or outpatient office by the
laboratory staff upon completion. The laboratory employee will identify the
results as “Abnormal”.
These results do not require the critical call back protocol be
initiated. These abnormal (but not critical) values are listed
below:
1. Microbiology
See POLICY 05 Guidelines for Reporting Critical and Abnormal
[Link] for further information.

2. Cytogenetics
All abnormal results are called to the ordering physician.

3. Cytology
All Rush or Stat reports and unexpected malignancy or infectious
organisms are communicated to the responsible clinician (or to the
number designated on the requisition form).

4. Surgical Pathology
All RAPID section (STAT) diagnoses are communicated to the
responsible clinician (or the number specified on the requisition slip).
All Products of Conception with a diagnosis of “Decidua, no villi seen”
are communicated to the responsible clinician.
Any unusual and/or unexpected findings are communicated to the
responsible clinician at the earliest possible time.

5. Transfusion Services (Blood Bank)

When a Type and Screen is ordered on a patient scheduled for OR and
the screen is positive, the physician is called, and compatible units are
cross matched.
When a patient has an autologous unit collected and one of the
infectious disease screening tests is found to be positive, the physician
is notified by letter by the Blood Bank of Delmarva. Christiana Care
receives a copy of this letter.
Reactive HIVDI results differentiated as HIV-1 or HIV-2 are called to
the ordering physician if the patient is an outpatient or to the
patient’s nurse if an inpatient.