Critical (panic) value notification: an established laboratory practice policy (parameter)

Article Abstract:

While many laboratory tests that are performed yield values that are within the normal range, a substantial number of test results are outside this range, or abnormal. Particularly low or high levels of certain components in the blood indicate a medical emergency; it is vital to the patient's health that the physician be notified immediately by the laboratory. One example is a blood potassium level below 2.6 millimoles/liter; abnormally low potassium can cause dizziness, mental confusion and even heart failure. While laboratory personnel have traditionally been most concerned with performing the tests accurately, the modern medical system requires that they also fulfill vital duties as communicators. The critical (panic) value of a laboratory test is the cutoff at which the patient's medical condition is so different from normal that it is life threatening and must be treated promptly. Each hospital should define critical values for all appropriate tests and train laboratory personnel to first verify the accuracy of their findings and then immediately notify the patient's doctor or whoever is responsible for taking action to treat the patient. An article by Kost in the February 2, 1990 issue of The Journal of the American Medical Association presents a review of critical value reporting policies in many hospitals; this information should be very valuable to the individual hospital that is setting up or revising such a policy. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Surveys, Medical protocols, Communication in medicine, Medical communication, editorial

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Regulations for implementing Clinical Laboratory Improvement Amendments of 1988: a summary

Article Abstract:

The Clinical Laboratory Improvement Amendments (CLIA) of 1988 set standards to improve the quality of clinical laboratory testing. The CLIA establishes three categories of laboratory tests based on their complexity: waived tests, tests of moderate complexity and tests of high complexity. Laboratories that perform only waived tests may apply for a certificate of waiver, and are not required to adhere to CLIA standards. Laboratories that perform moderate and high complexity tests are required to meet CLIA standards, and to apply for certification. Certified laboratories must undergo proficiency testing and have a system for tracking patient specimens throughout testing. Laboratories must follow a written set of quality control procedures to insure accurate test results. Laboratory personnel who perform moderate and high complexity tests must have certain qualifications, and perform certain functions. A special set of regulations have been established for cytology laboratories. Government officials can make unannounced inspections of clinical laboratories. A committee of experts in laboratory medicine has been formed to make recommendations on the CLIA.

Biomedical technicians

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Managed care: a work in progress

Article Abstract:

The rise of managed care has contained costs and cost-containment is likely to continue. Despite media reports of overpaid CEOs and gag rules, there is no evidence that managed care has caused a decline in the quality of care. Nevertheless, managed care plans should be accountable to the public. There are many tools to measure health outcomes and patient satisfaction. The recently established Foundation for Accountability has published outcomes measures for diabetes, breast cancer, depression and patient satisfaction. The foundation includes representatives from provider and patient groups.

Editorial, Analysis, Managed care plans (Medical care), Health care reform

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