Critical and Urgent Values & Results

Critical and Urgent Values & Results

Values listed are for outpatient/reference laboratory clients only.

Cleveland Clinic Providers: Inpatient values are listed on the RT-PLMI Intranet.

Critical Results & Values

These test results are defined as those that indicate the patient is in danger of death unless treatment is initiated immediately.

Critical results require immediate interruptive notification of the responsible licensed caregiver who can initiate the appropriate clinical action for the patient.

Client Services or laboratory personnel are responsible for reporting critical results within 30 minutes of the result being known.

Cleveland Clinic Laboratories will immediately notify the individual who requested a test when any result indicates an imminent, life-threatening condition. This policy is compliant with CLIA regulation 493.1109 (f).

Test

Low Value

High Value

Glucose

Less than 40 mg/dL

None

Test

Low Value

High Value

Hematocrit

Less than 15.0%

None

Test

Low Value

High Value

Hemoglobin

Less than 6 g/dL

None

Test

Low Value

High Value

Platelets*

Less than 10 K/μL

None

*Note: If the lab has documented communication of a preliminary critical platelet count, there will not be an additional call with the final result under the following circumstances:

• the final value does not change at all.
• the final value changes, but is still critical.
• the final value becomes non-critical.

Test

Low Value

High Value

Potassium

Less than 2.5 mmol/L

None

Test

Low Value

High Value

Activated Partial Thromboplastin Time (PTT)

Activated Partial Thromboplastin Time, Anticoagulant Therapy (PTTAC)

None

Extremely abnormal result. No clot detected. Refer to Anticoagulation Nomogram for further actions.

Test

Low Value

High Value

CO2

Less than 10 mmol/L

None

Urgent Results & Values

These values are test results that fall outside of a normal range and represent a significant finding for the patient or indicate a need for infection control precautions to be initiated.

Urgent results and values require prompt communication to, and attention from, the patient’s caregiver.

Results are provided by Client Services immediately after any pending critical values are called. While there is no national standard for calling urgent values, every effort is made to call urgent values within approximately two hours from result availability.

Urgent values are reported to a responsible licensed caregiver, and an accurate read back of the communication is requested. All actions are documented.

Chemistry

Test

Low Value

High Value

Patient Info

Bilirubin, total

None

> 15.0 mg/dL or QNS

Non-neonates (≥ 31 days old)

Calcium

< 7.0 mg/dL

> 14.0 mg/dL

Neonates (< 30 days old)

< 6.0 mg/dL

> 14.0 mg/dL

Non-neonates (≥ 31 days old)

Calcium, ionized

< 0.9 mmol/L

> 1.5 mmol/L

Carboxyhemoglobin

None

> 20%

Glucose

None

> 500 mg/dL

Lactic Acid (Lactate)

None

> 4.0 mmol/L

Magnesium

< 1.0 mg/dL

> 6.0 mg/dL

Phosphorus

< 1.1 mg/dL

None

Sepsis Lactate

None

> 2.0 mmol/L

Sodium

< 120 mmol/L

> 160 mmol/L

High-Sensitivity Troponin T

None

≥ 52 ng/L

Called once every 24 hours

Hematology/Coagulation

Test

Low Value

High Value

Patient Info

Activated Partial Thromboplastin Time (aPTT)

None

> 100 sec

ADAMTS13

< 10%

None

Anti PF4 Elisa Assay (Heparin Antibody)

None

> 0.400 OD reading with more than 50% inhibition with excess heparin

Factor Assay

< 5%

None

Fibrinogen

< 100 mg/dL

None

Hematocrit

< 26%

> 65%

Neonates (< 30 days old)

International Normalised Ratio (INR)

None

> 5.0

Prothrombin Time (PT/INR)

None

Extremely abnormal result. No clot detected. Refer to Anticoagulation Nomogram for further actions.

Platelets

< 20 K/μL
(call once every 72 hours)

White Blood Count

< 1.01 K/μL

> 74.99 K/μL

Non-neonates (≥ 31 days old)

< 4.0 K/μL

> 30.0 K/μL

Neonates (< 30 days old)

Microbiology

*Note: Outpatient positive results are called between 8 a.m. and 8 p.m.  Results that become available after 8 p.m. are called the next day after 8 a.m.

Primary Test

Result

Primary Test

Result

Acid-Fast Bacteria (AFB), Culture & Stain*

Positive (initial “AFB” result) & ID of M. tuberculosis

Eye Culture

Positive (initial detection of organism)

Will not call organisms listed as probable contaminant.

AFB, Culture Only*

Positive (initial “AFB” result) & ID of M. tuberculosis

Eye Culture & Gram Stain

Positive (initial detection of organism)

Will not call organisms listed as probable contaminant.

AFB, Stain Only*

Positive (initial “AFB” result) & ID of M. tuberculosis

Gram Stain

from a normally sterile site (e.g. CSF, body fluid, eye, tissue)

Positive

Blood Culture

Positive (initial Gram stain)

Herpes Simplex Virus (HSV) by PCR, CSF

Positive

Blood Culture, Special

Positive (initial Gram stain)

Mycobacterium tuberculosis (MTB) Complex, PCR

on Smear-Positive Specimens

Positive for Mycobacterium tuberculosis

Blood Parasites

Positive

MTB Complex, PCR

on Smear-Positive FFPE Tissue

Positive for Mycobacterium tuberculosis

Body Fluid, Culture & Stain

Positive (initial detection of organism)

Organism Identification

Mycobacterium tuberculosis

Cerebrospinal Fluid (CSF), Culture & Stain

Positive (initial detection of organism)

Tissue Culture & Stain

from a normally sterile site

Positive (initial detection of organsim)

Enterovirus PCR

Positive

Toxic Drug Levels

There are no urgent low values for toxic drugs, except for Methotrexate, for which all values are called.

Test

High Value

Test

High Value

Acetaminophen

> 150.0 μg/mL
(>4hr post-ingestion)

Mexiletine

> 3.0 ng/mL

Amikacin, Random

> 40.0 μg/mL

Nordoxepin

> 500 ng/mL

Amikacin, Pre

> 8.0 μg/mL

Nortriptyline

> 500 ng/mL

Amikacin, Post

> 40.0 μg/mL

Oxcarbazepine

> 40 μg/mL

Amiodarone/DEA

> 40.0 μg/mL

Pentobarbital

> 40 μg/mL

Amitriptyline

> 500 ng/mL

Phenobarbital

> 60.0 μg/mL

Caffeine

> 30 μg/mL

Phenobarbital, Free

> 25.0 μg/mL

Carbamazepine (Tegretol)

> 15.0 μg/mL

Phenytoin (Dilantin)

> 40.0 μg/mL

Carbamazepine-10, 11-Epoxide

> 15.0 μg/mL

Phenytoin, Free

> 4.0 μg/mL

Carbamazepine, Free

> 5.0 μg/mL

Primadone

> 18.0 μg/mL

Cyclosporine

> 2000 ng/mL

Procainamide

> 15.0 μg/mL

Desipramine

> 500 ng/mL

Quinidine

> 7.0 μg/mL

Digoxin

> 3.0 ng/mL

Rapamycin

> 30 ng/mL

Disopyramide

> 7.0 μg/mL

Salicylate

> 40.0 mg/dL

Doxepine

> 500 ng/mL

Tacrolimus

> 30.0 ng/mL

Everolimus

> 30 ng/mL

Theophylline

> 30.0 μg/mL

Ethosuximide

> 150.0 μg/mL

Thiocyanate

> 5.0 mg/dL

Gentamicin, Random

> 20.0 μg/mL

Tobramycin, Random

> 20.0 μg/mL

Gentamicin, Pre (Trough)

> 2.0 μg/mL

Tobramycin, Pre (Trough)

> 2.0 μg/mL

Gentamicin, Post (Peak)

> 20.0 μg/mL

Tobramycin, Post (Peak)

> 20.0 μg/mL

Imipramine

> 500 ng/mL

Valproic Acid

> 150.0 μg/mL

Lead, Blood

> 44.9 μg/mL

Valproic Acid, Free

> 75.0 μg/mL

Lidocaine

> 8.0 μg/mL

Vancomycin

> 50.0 μg/mL

Lithium

> 2.0 mmol/L

Zinc Protoporphyrins

(0–13 years)

> 35 μg/mL

Methotrexate

All values

Zinc Protoporphyrins

(> 13 years)

> 100 μg/mL

Methylmalonic Acid

> 50,000 nmol/L