Friday, October 21, 2011

The Critical Value of Lab Tests

Many months ago our hospital "improved" the laboratory critical value list.

In the resulting tsunami of early AM phone calls for critically chronically low albumin levels in the malnourished, high bicarbs in lungers and multiple 3.4 meq/dl potassiums, one test stood out: INR/protimes.

I was called for every therapeutic(and many subtherapeutic 1.6+) INR on my warfarin patients.

I "improved" my results by ordering fewer tests, especially those I expected to trigger a call, until our medstaff successfully pushed back the expanded rules (see here for a study of the problem elsewhere). The INR standard was altered to accommodate anticoagulated patients, so the calls abated. Until today.

This morning I was called for a "critical" normal INR of 0.9 in a (non-anticoagulated) liver patient.

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