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Critical Risk Results


Critical risk results are those results that indicate a high risk of morbidity or mortality in the absence of clinical evaluation and medical intervention.

It is the policy of the laboratory to notify the ordering location of any laboratory results that indicate a potentially dangerous condition requiring immediate attention by the clinician. Critical risk results from laboratory examinations are always reported by telephone even to those areas with computer printers or terminals.

Critical risk results may vary by institution, based on the patient population at that location. The standard critical risk alert thresholds for University of Washington Medical Center (UWMC), Harborview Medical Center (HMC) and Northwest Hospital are listed below.

ANALYTE

CRITICAL RISK ALERT THRESHOLDS

Absolute Neutrophil (non-oncology)
  • UWMC/NWH: <0.5 THOU/mcL
  • HMC: <1.0 THOU/mcL
Anti-Xa for Heparin Infusion >0.90 IU/mL
Bicarbonate (HCO3-) <10 or >40 meq/L
Bilirubin, newborn (under 30 days old) >12.0 mg/dL
Blood Gases, Adult (arterial)
  • pH
  • pCO2
  • pO2
 
  • <7.20 or >7.58
  • <9 or >65 mmHg
  • <40 mmHg
Blood Gases, newborn (under 30 days old)
  • pH (arterial and venous)
  • pCO2 (arterial and venous)
  • pO2 (arterial)

  • <7.25 or >7.50
  • <30 or >50 mmHg
  • <50 or >90 mmHg
Calcium, ionized <0.78 or >1.58 mmol/L
Calcium, total <6.0 or >13.0 mg/dL
Carbon Monoxide >20%
Fibrinogen <100 mg/dL
Glucose (including POCT)
  • Newborn (under 30 days old)
  • Adult
  • Adult OB patients (at 1 hour pp)

  • <40 or >200 mg/dL
  • <50 or >500 mg/dL
  • <50 or >200 mg/dL
Glucose, CSF <20 mg/dL
Hematocrit
  • UWMC/NWH: <20%
  • HMC: <20% (first critical value per inpatient admission)
Hemoglobin by oximetry
  • Newborn (under 30 days old)
  • Adult

  • <8.1 g/dL or >21.1 g/dL
  • <6.0 g/dL
Lead ≥70 mcg/dL
Magnesium <1.2 or >4.7 mg/dL
Methemoglobin >30.0%
Osmolality <250 or >350 mOsm/kg
Partial thromboplastin time >120 sec
Phosphate <1.0 mg/dL
Platelet Count UWMC/NWH:
  • Pediatric: <60 THOU/mcL
  • Infants (NICU only): <60 THOU/mcL
  • Adults (non-Oncology)<20 THOU/mcL
HMC:
  • Outpatients: <40 THOU/mcL
  • Inpatients: <20 THOU/mcL (first critical value per inpatient admission)
Potassium <2.5 or >6.0 meq/L
Prothrombin Time INR >5
Sodium <120 or >160 meq/L
T4
  • Newborns (under 30 days old)
  • Adult
 
  • <3.5 or >18.0 mcg/dL
  • >18.0 mcg/dL
Troponin I ≥0.40 ng/mL
(first critical value per 48 hour period for each patient)

When a test is ordered that is a part of a panel without ordering the full panel, some testing instruments perform the entire panel (e.g., blood gases, or complete blood count), but unordered tests are not reported in the medical record or charged. However, if the results of an unordered test exceed the critical risk alert threshold, the critical risk result will be called to the ordering location. At that time, the ordering location will have the opportunity to order the test, so that the critical risk result may be documented in the medical record.

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Critical Risk Results for Microbiology

Critical risk results in Microbiology are results that indicate a potentially dangerous condition requiring immediate attention by the clinician. Critical risk results are always reported by telephone. In accordance with The Joint Commission (TJC) requirements, it is required that we request and receive a read-back of results to ensure that the results were properly noted by the recipient. They include the following:

  • Positive blood culture
  • Positive direct exam or culture on spinal fluid (CSF)
  • Positive Cryptococcal antigen (serum or CSF)
  • Positive Pneumocystis stain
  • Positive direct exam on any specimen from the Operating Room
  • Positive AFB stain or culture from any specimen
  • Eye culture positive with:
    • Acanthamoeba species
    • Bacillus species
    • Neisseria gonorrhoeae
    • Pseudomonas aeruginosa
    • Staphylococcus aureus
  • Positive Herpes simplex virus PCR on cerebral spinal fluid (CSF)

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Toxic Drug Levels

Toxic Drug Levels are those results that are so far from the therapeutic range that they indicate a potentially dangerous condition requiring immediate attention by the clinician. CRITICAL RISK RESULTS ARE ALWAYS REPORTED BY TELEPHONE. In accordance with The Joint Commission (TJC) requirements, it is required that we request and receive a read-back of results to ensure that the results were properly noted by the recipient.

DRUG

TOXIC LEVEL

Acetaminophen >50 mcg/mL
Alcohol (Methyl) >24 mg/dL
Amikacin (Trough) >30.0 mcg/mL
Caffeine ≥50.0 mcg/mL
Carbamazepine >14.0 mcg/mL
Cyclosporine by LC-MS/MS (Trough) >600 ng/mL
Digoxin >3.0 ng/mL
Ethylene Glycol ≥10 mg/dL
Gentamicin (Trough) >10.0 mcg/mL
Isopropanol and Acetone >200 mg/dL
Lidocaine >7.0 mcg/mL
Lithium >2.0 mEg/L
Methotrexate >100 mcmol/L
Phenobarbital >60.0 mcg/mL
Phenytoin (Dilantin) >30.0 mcg/mL
Phenytoin, Free >4.0 mcg/mL
Salicylate >50 mg/dL
Theophylline >25.0 mcg/mL
Thiocyanate >20 mg/dL
Tobramycin (Trough) >10.0 mcg/mL
Tricyclic Antidepressants >500 ng/mL
Vancomycin (Trough) >40.0 mcg/mL
Valproic Acid (VPA) >200 mcg/mL

Critical risk results last reviewed: March 7, 2017
Page last updated: 03/07/2017

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