Memo

 To: Charles H. Parker, M. D., Chief of Medicine

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

Subject: Alert Value Reporting Policy

Date: July 12, 2005

Alert-value reporting -- Prompt phone reporting of significantly abnormal laboratory test results is important if these results reflect an abnormality that may require immediate modification of patient therapy. 

That is a simple and straightforward premise -- and we have been following some form of that policy for over 20 years.  As this policy is a direct result of laboratory testing and has a direct impact on patient care, the operational features of Alert-value reporting require input from LMC's Medical Staff.  Some features that require discussion include:

1. What tests and what range of abnormalities warrant 24/7 phone call alerts?

2. Should repeat alert values be called if the abnormality persists in a testing series?

3. Who should be called?

1. While LMC's Laboratory team has phoned abnormal results since the old days of "Panic Values" (which we changed to "Alert" values), JCAHO requirements have recently mandated detailed documentation of the process.  Thus the call must be made, results must be read back, and documentation of the call recorded on both ends. 

   The medical staff retains the responsibility to determine what tests and what abnormality ranges fall within 24/7 alert call range. 

   (A copy of current Alert Ranges is enclosed for your comments and suggestions.)

2. Regarding repeat alert values, there is occasional sentiment that all Alert Value results should be called.  This leads to the redundant situation of calling repeat thrombocytopenias in chemotherapy patients, elevated BUN and creatinine results in dialysis patients, etc. 

   All laboratory reports are immediately electronically transferred to the floor and immediately printed.  All results are immediately available online, and all results are added daily to the cumulative summary lab report each night.  Therefore there seems to be no necessity and much unnecessary effort (on both ends) involved with repeat calling of repeated Alert Range abnormalities.  We suggest discontinuance of that practice.  

3. Who should be called: This can be complex on evenings, nights and holidays.  Strictly speaking, the physician who ordered the test should be notified.  The nurse-in-charge can easily be called w/ in-patient Alerts, with her/his discretion and knowledge of the proper physician notification. 

   Outpatient Alerts may be more complex, and we'll appreciate your suggestions on OP call thresholds. 

Please let me know and thank you for your time and ideas.