At the Jewish General's lab I instituted a policy somewhat different to those in Being used in the UK.
We determined our own critical values which we discussed with some hospital colleagues. We have two sets of critical values, one that must be phoned 24 hours a day and one that can be left until the next morning.
We then, using all the doctors fax numbers in our LIS, we sent the letters explaining we were changing the critical values (including the tables of values and when they would be phoned). We have electronically documented that they were received by every doctor that uses the lab (or their clinic or ward). Only one person got back to us about Li critical levels.
Critical values are stopped at the interface of the analyser and the technologist phones the doctor, ward, clinic and documents the name of the person spoken to using the interface. (We may review this and have a dedicated person call all critical results during the work day until 8pm).
If the technologist can't contact a human being who can take charge of the critical result they call the Medical Biochemist (doctor) on call who looks at all the information we have and decides if the patient must be contacted at home. If the patient can't be contacted or seems not capable of understanding what is going on we decide if we need to call the police or ambulance. We can access the LIS from our homes.
In Canada, and I feel sure in many parts of the world, once you know that a patient is at risk you have an ethical and legal responsibility to act on that information. I guess that being said I just wonder what is the legal position in other countries.
Hopefully this is of some help
Elizabeth Mac Namara
On 2012-01-04, at 4:44 PM, "Hallworth Mike (RLZ)" <[log in to unmask]<mailto:[log in to unmask]>> wrote:
We basically follow the RCPath out of hours procedure for analytes and limits with scope for discretion by Duty Biochemist.
http://www.rcpath.org/resources/pdf/g025_outofhoursreporting_nov10.pdf
A Duty Biochemist is on duty in the lab until 2100, which covers the vast majority of primary care abnormalities detected. DB contacts deputising service with abnormal results, following RCPath limits but using discretion (e.g. we wouldn't phone a low sodium if it was already known to be at that level). The DB is a qualified clinical scientist.
Primary care practice phoned with results the following morning.
Mike
________________________________
From: Clinical biochemistry discussion list [mailto:[log in to unmask]] On Behalf Of Smith Helen - Consultant Clinical Biochemist
Sent: 04 January 2012 16:24
To: [log in to unmask]<mailto:[log in to unmask]>
Subject: abnormal results in the middle of the night
Dear All,
May I ask what your lab. does with grossly abnormal results from primary care that are analysed in the middle of the night?
What analyte results & at what level would your lab. 'phone the out of hours service?
Who 'phones results? BMS/Clinical Scientist/Medical staff/other?
Many thanks for your responses.
Happy New Year
Helen
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