Memo

To: Tripp Jones, M. D., Director of Oncology Services, LMC

From: John B. Carter, M. D., Director of Clinical Laboratories

Subject: Alert Value Notification of Sustained Thrombocytopenias

Date: March 22, 2005

You're familiar with our alert value policy ("panic values" in some hospitals) whereby we phone the clinical service if a laboratory test result is critically outside the normal range to the point where rapid changes in patient care management may be necessary.

Of course this is important in patients with new or previously unsuspected severe thrombocytopenias. Our alert value threshold for prompt verbal notification for platelet counts is <30,000 (<50,000 for OP's).

Once clinical attention has been called on an alert lab value that is likely to remain unchanged, we do not call repeat alerts each time a test result is encountered in the alert range. (We do not phone call repeated alert-range BUN and creatinine results in patients whose diagnosis of renal failure has already been established.)

I've been told that Nursing staff has requested that all patients with severe thrombocytopenia be "alert-valued" -- every time. This has a significant impact relative to the Oncology service where most thrombocytopenias are due to chemotherapy. Never-the-less we're told that the lab team should call your nursing team each and every time a platelet count is noted <30,000 on each and every patient. This results in a very large number of calls every day and certainly in a significant interruption to the nursing staff as well as to our laboratory team. Could this not be discontinued or placed in a more reasonable protocol, e.g. calling the first "alert" notification, then not further calling if the thrombocytopenia remains stable?

Thank you.

(posted 06 April 2005)