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As part of the continuing updating of processes in the laboratory I have come to review the levels at which the MLSOs check results by repeat assay and phone them to the clinician. The list and range of tests is very "historical" and has travelled with me from the early 1970s when analysers may not have been so reliable. This is a separate process from and takes place before clinical authorisation, the latter frequently involving phone contact. A set of rules is used to trap based on patient location, delta checks, test, reference, abnormal and panic ranges. Apart from paper reports the hospital intranet allows all results to be avalable on any networked PC and results are sent electronically to 16 GP practices so that results availability should not be a problem. During a recent visit to the lab at Nottingham and in discussion with a colleague who works at both Guy's and Lewisham I have noticed some differences in both the analytes included and the set values. Obviously whether a result is phoned depends on many factors associated with the individual patient other than a "number". However Clinical Governance is upon us. What guidelines should we have? I am reminded of two cases of legal enquiries into deaths here in the past 5 years. In both cases we did not phone results as they were inside our limits, noticed by the biochemist when authorising reportsand appropriate comments added but just issued as normal reports. If the test results had been known by the requesting clinician there may have been more rapid treatment of the patients and in one case may have prevented his demise. In both cases there were other far more serious problems associated with their management. However I was asked by one solicitor to provide a list of tests and values outside which the results would be phoned to the GP and whether there were national guidelines for these. These are the list of tests and values outside which the MLSO phones results - assuming sample is not old/haemolysed. It covers all tests currently assayed on the Vitros 250/950 systems. Perhaps you will understand why I need to review the list and values. Glucose Less than 2.0 Above 20 mmol/L Urea " 35 " Sodium " 120 " 155 " Potassium " 2.7 " 5.5 " Calcium " 1.8 " 2.8 " Urate in pregnancy " 0.4 " These are the tests and values outside which we repeat assay the sample before releasing results: Potassium Less than 2.5 Above 6.0 mmol/L Glucose " 2.0 " 20 " Sodium " 120 " 150 " Calcium " 1.8 " 3.0 " Phosphate " 0.4 We have a separate process for rapidly dealing with grossly abnormal endocrine and other miscellaneous tests. Are there any published guidelines on this subject ? Which analytes to you check by reassay and why ? Which tests and ranges do you use as phone limits ? Do you have other policies on phoning ? I shall produce a summary of responses received in the next 10 days. Thanks Paul Eldridge Phone 44 181 333 3255 University Hospital Lewisham Fax 44 181 690 8891 London SE13 6LH %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%