1 Clarify the definition of "critical value"
The so-called "critical value" test means that when the test results appear, it means that the patient may be on the verge of life-threatening. If timely and effective treatment can be given at this time, the patient's life can be saved or effectively improved. Otherwise, adverse consequences may occur. Because this is a life-threatening test result, this test value is called "critical value" ".
2 Develop undergraduate “critical value” items, reporting systems and “critical value” scope based on clinical practice
2.1 Develop “critical value” items
We are in and On the basis of full clinical discussions, the "critical value" items of our department were formulated, which are serum potassium, sodium, chloride, calcium, magnesium, blood sugar, urea nitrogen, creatinine, amylase, urinary trypsinogen II (qualitative), Troponin (qualitative), creatine kinase isoenzyme, carbon dioxide binding capacity.
2.2 Establish a "critical value" reporting system for the laboratory department
Proficiently master the "critical value" range of various critical value items and understand their clinical significance; when the "critical value" occurs , the inspector of the project should immediately re-check after confirming that the instrument is operating normally. After the re-check results are correct, the critical test results of the project should be urgently notified to the medical staff responsible for treatment. Regardless of routine diagnosis or emergency, the report should be reported immediately Report to the clinic and prepare corresponding critical value report records and signatures of relevant personnel, and briefly inquire about the patient's condition and medication usage during sampling. The record should contain the following contents: patient’s name, gender, age, department, hospitalization number, clinical diagnosis, applying doctor, test items, test results, specimen receipt time, report time, test reporter, notification method, and receiving medical staff. Carry out indoor quality control to ensure the accuracy of inspection results, and do not issue unsafe or questionable inspection results. Keep all relevant "critical value" information, including test result records, report records, and signatures of the report recipients, as well as indoor quality control records. The operation manual should include the project operating procedures for the "critical value" test and the "critical value" range. The work related to critical values ??must be reviewed and summarized regularly, at least once a year.
3 Develop the reporting scope and clinical significance of the "critical value" item
See Table 1 and Table 2. Table 1 "Critical value" range and possible clinical consequences of critical value items Critical value items (omitted) Table 2 Neonatal critical value items that must be reported to clinicians (omitted)
3 Establish "critical value" The significance of the reporting system
3.1 Strengthened communication with the clinic and enhanced the sense of responsibility of the inspectors
When a critical value occurs, the inspectors will carefully analyze the inspection results according to the system and report them in a timely manner Taking the initiative to contact the clinic has strengthened the initiative and sense of responsibility of the testing staff, strengthened the relationship with the clinic, and reduced conflicts. More importantly, our timely communication with the clinic has enabled some patients to receive timely treatment.
3.2 Improve the theoretical level of inspectors and strengthen the combination of theory and practice. When the critical value test results come out, we need to analyze them in conjunction with clinical diagnosis. The analysis process is a learning process. As long as the long-term If we persist, we will definitely improve our level of testing and diagnosis in an all-round way, and our awareness of participating in clinical diagnosis and treatment. It will also indirectly improve the status of our testing personnel in the hearts of clinical medical staff, and increase the clinical understanding and trust of us.
In addition, it should be noted that due to the complexity of the human body and the influence of other experimental factors, the critical value will be affected by at least the following factors: patient age (newborn, children, adults), gender, race and other different groups of people The critical value limits may be different; the critical value items and critical values ??used in different departments such as outpatient clinics, emergency rooms, operating rooms, intensive care units, etc. have different emphasis; different detection methods may have different reference value ranges, which may Specific limits affecting the critical value. Therefore, it is impossible to have a unified critical value item that is suitable for the overall use of patients in our department.
In short, in actual work, we must closely contact the clinic to do this work well, and it is our responsibility to better serve patients.
References:
[1] Kou Lijun. Critical application in clinical laboratory work [J]. Experiment and Clinical, 2003, 2: 32.
(Hejin People's Hospital, Hejin, Shanxi 043300)
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