A blood test comes back with a critical value result. Should it be repeated?

Christopher M. Lehman, Peter J. Howanitz, Rhona Souers, and Donald S. Karcher (2014) Utility of Repeat Testing of Critical Values: A Q-Probes Analysis of 86 Clinical Laboratories. Archives of Pathology & Laboratory Medicine: June 2014, Vol. 138, No. 6, pp. 788-793.

CAP LABORATORY IMPROVEMENT PROGRAMS

Utility of Repeat Testing of Critical Values: A Q-Probes Analysis of 86 Clinical Laboratories

Christopher M. Lehman, MD; Peter J. Howanitz, MD; Rhona Souers, MS; Donald S. Karcher, MD

From the Pathology Department, University of Utah Health Care, Salt Lake City (Dr Lehman); the Pathology Department, State University of New York Downstate Medical Center, Brooklyn (Dr Howanitz); the Biostatistics Division, College of American Pathologists, Northfield, Illinois (Ms Souers); and the Pathology Department, George Washington University Medical Center, Washington, DC (Dr Karcher).

Context.— A common laboratory practice is to repeat critical values before reporting the test results to the clinical care provider. This may be an unnecessary step that delays the reporting of critical test results without adding value to the accuracy of the test result.

Objectives.— To determine the proportions of repeated chemistry and hematology critical values that differ significantly from the original value as defined by the participating laboratory, to determine the threshold differences defined by the laboratory as clinically significant, and to determine the additional time required to analyze the repeat test.

Design.— Participants prospectively reviewed critical test results for 4 laboratory tests: glucose, potassium, white blood cell count, and platelet count. Participants reported the following information: initial and repeated test result; time initial and repeat results were first known to laboratory staff; critical result notification time; if the repeat result was still a critical result; if the repeat result was significantly different from the initial result, as judged by the laboratory professional or policy; significant difference threshold, as defined by the laboratory; the make and model of the instrument used for primary and repeat testing.

Results.— Routine, repeat analysis of critical values is a common practice. Most laboratories did not formally define a significant difference between repeat results. Repeated results were rarely considered significantly different. Median repeated times were at least 17 to 21 minutes for 10% of laboratories. Twenty percent of laboratories reported at least 1 incident in the last calendar year of delayed result reporting that clinicians indicated had adversely affected patient care.

Conclusion.— Routine repeat analysis of automated chemistry and hematology critical values is unlikely to be clinically useful and may adversely affect patient care.