HOW PROMPTLY ARE INPATIENTS TREATED FOR CRITICAL LABORATORY RESULTS

Objective: The purpose of the study is to determine how frequently cri tical laboratory results (CLRs) occur and how rapidly they are acted u pon. A CLR was defined as a result that met either the critical report ing criteria used by the laboratory at Brigham and Women's Hospital or other, more complex criteria. Design: This is a retrospective cohort study in a large academic tertiary-care hospital. Measurements: The pr oportion of chemistry and hematology results obtained in a 13-day peri od that met the hospital laboratory's critical reporting criteria were calculated. The charts of a stratified random sample of patients with CLRs due to sodium, potassium, and glucose were reviewed to determine the time interval until an appropriate treatment was ordered and the time interval until the critical condition was resolved. Results: In 1 3 days, 1938 of 201,037 laboratory results (0.96%, or 0.44 per patient -day) met the hospital's critical reporting criteria. In the chart rev iew, 222 CLRs were included in the stratified random sample, and 99 of these met the inclusion criteria. Among these 99 CLRs, the median tim e interval until an appropriate treatment was ordered was 2.5 hours. T his interval was 1.8 hours when the CLR met the laboratory's criteria and a phone call was made, and 2.8 hours when the CLR met more complex criteria not requiring a phone call (p = 0.07). For 27 (27%) of the C LRs, an appropriate treatment was ordered only after five or more hour s. The median time until the condition resolved was 14.3 hours: 12.0 h ours for CLRs that met the hospital's criteria and 20.9 hours for the CLRs that met the more complex criteria (p = 0.006). Conclusion: Altho ugh CLRs meeting the hospital's criteria were reported promptly by the laboratory, treatment delays were still common. Results that did not meet the hospital's critical criteria but still represented serious cl inical situations were more often associated with treatment delays. Di fficulty communicating critical results directly to the responsible ca regiver is the likely cause of some delays in treatment. New communica tions methods, including computer-based technologies, should be explor ed and tested for their potential to reduce treatment delays and impro ve clinical care.