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How Promptly Are Inpatients Treated for Critical Laboratory Results?

Affiliation of the authors: The Division of Clinical Systems Research and Development (GJK, JMT, DWB), the Division of General Internal Medicine (DB, AJ, ER, NM'L, DWB), and the Clinical Laboratories (MJT, JW) of Brigham and Women's Hospital, Partners Healthcare System, Boston, MA.

Correspondence and reprints: Gilad J. Kuperman, MD, PhD, Department of Information Systems, Partners Healthcare System, 850 Boylston Street, Suite 202, Chestnut Hill, MA 02167. e-mail: <gjkuperman{at}bics.bwh.harvard.edu>.

Abstract Objective: The purpose of the study is to determine how frequently critical laboratory results (CLRs) occur and how rapidly they are acted upon. A CLR was defined as a result that met either the critical reporting 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 proportion of chemistry and hematology results obtained in a 13-day period 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 13 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 review, 222 CLRs were included in the stratified random sample, and 99 of these met the inclusion criteria. Among these 99 CLRs, the median time interval until an appropriate treatment was ordered was 2.5 hours. This 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 CLRs, an appropriate treatment was ordered only after five or more hours. The median time until the condition resolved was 14.3 hours: 12.0 hours 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: Although 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 clinical situations were more often associated with treatment delays. Difficulty communicating critical results directly to the responsible caregiver is the likely cause of some delays in treatment. New communications methods, including computer-based technologies, should be explored and tested for their potential to reduce treatment delays and improve clinical care.

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