Critical Values List

Red

Red alert critical values are those laboratory results that are the most urgent and may require clinical intervention within 60 minutes.

These have been set by the laboratory in consultation with the medical staff and the Patient Safety Care Committee. The laboratory will try to reach the submitting physician immediately with red alert critical values.

Hematology

  • Anticoagulants (decision to change dosage should be made promptly)
  • INR > 5
  • PTT > 135 seconds, notify RN if RN in charge of protocol
  • Fibrinogen < 100 mg/dL, first incidence of extremes of blood count that have significantly changed (stable counts of extreme values should not be alerted)
  • HGB < 7.0 g/dL and then again if < 5.0 g/dL
  • HCT < 21% and then again if < 15%
  • PLT > 1,000,000 or < 20,000 and then again for < 10,000 or < 150,000 with a > 50,000 decrease
  • Bacteria in sterile body fluids

Microbiology

All positive results of the following:

  • Rapid antigen detection of cryptococcus
  • Urine gram stains in children < 2 months old in the ED
  • First incidence and every three days thereafter, or different result of blood cultures
  • Positive AFB’s, first occurrence, different admission, different site
  • Gonorrhea culture/probes from the eye
  • First incidence, new site, new admission, different result of clinical smears, culture or molecular assays from sterile sites

Chemistry

In all situations

  • Glucose < 55 or > 400 mg/dL
  • Phosphorous < 1.0 mg/dL
  • Potassium < 3.0 or > 6.0 mEq/L
  • Sodium < 125 mEq/L

Transfusion

Positive gram stain on a blood component associated with a transfusion reaction. Positive direct coombs test or hemoglobinemia in a post transfusion reaction specimen, where the pretransfusion direct coombs test is negative or hemoglobinemia is not present in the pretransfusion specimen.

Orange

Orange alert critical values are those laboratory results that may require clinical intervention, but the time frame is less urgent (generally within 6 to 8 hours.)

The laboratory will try to reach the submitting physician within several hours of an orange alert critical value.

Hematology

  • New diagnosis of hematologic malignancies
  • Positive blood smear for parasites
  • WBC > 50,000 or an absolute neutrophil count of < 500
  • Blasts on smear
  • Reticulocytes 0% in patient with anemia

Chemistry

  • Ammonia > 100 umols/L
  • Amylase > 200 u/L
  • Bicarbonate < 12 or > 40 mEq/L
  • Calcium < 7 or > 11.5 mg/dL
  • Chloride < 85 or > 120 mEq/L
  • Cortisol AM < 2.0 ug/dL
  • Cortisol PM < 2.0 ug/dL
  • Iron > 300 ug/dL
  • Lactic Acid > 3.9 mEq/L
  • Magnesium < 0.7 or > 2.3 mEq/dL
  • Neonatal Bilirubin > 14.9 mg/dL
  • Sodium > 150 mEq/L
  • T4 < 2.0 or > 18.0 ug/dL
  • TP < 4.0 g/dl or > 12.9 g/dl

First incidence of:

  • Albumin < 1.5 g/dL
  • BUN > 65 mg/dL
  • Creatinine > 5.0 mg/dL

Toxicology

  • Acetaminophen > 50 ug/mL
  • Carbamazepine > 15 mcg/mL
  • Carboxyhemoglobin > 9%
  • Digoxin > 2.5 ng/mL
  • Dilantin > 30 ug/mL
  • Ethanol > 400 mg/dL
  • Gent (Pre) > 5 mcg/mL
  • Gent (Post) > 12 mcg/mL
  • Lithium > 1.6 mEq/L
  • Phenobarb > 80 mcg/mL
  • Procainamide + NAPA > 30 ug/mL
  • Quinidine > 7.0 ug/mL
  • Salicylate > 40 mg/dL
  • Theophylline > 30 ug/mL
  • Tobramycin > 10 ug/mL
  • Valproic Acid > 150 mcg/mL
  • Vanco (Pre) > 20 mcg/mL
  • Vanco (Post) > 80 mcg/mL

Reference Lab

As reported by the reference lab

Yellow

Yellow alert critical values are those laboratory results that may require clinical intervention within 1 to 3 days.

The laboratory will try to reach the submitting physician within a couple of days for any yellow alert critical values.

Hematology

Positive sickle cell on blood smear in previously unknown patient

Pathology

New malignancies in surgical pathology excluding basal cell and squamous cell carcinomas of the skin

Transfusion

Newly discovered positive antibody screen or new antibody detected in the context of a previous transfusion

Microbiology

First incidence for positive results of:

  • C. difficile
  • PCP
  • Respiratory viruses
  • Enteric pathogens, for example rotavirus, salmonella, shigella, giardia/crypto

First occurrence, inpatients only for positive results of:

  • MRSA, VRE, ESBL, CRE

Positive CMV on children < 2 months

All positive results of GC, CT and herpes on patients less than 14 years of age

Positive respiratory viruses of discharged patients in the Hasbro ED