top of page
Research Article





T Mukhopadhyay, A Subramanian,V Arya


ABSTRACT: Introduction: In order to improve the critical value notification (CVN) in our hematology laboratory of a busy trauma care set up, the study was planned with an aim of evaluating and improving the critical value notification process using the principles of Quality Improvement. Settings and Design: The pre-test/post-test intervention study was conducted in the hematology laboratory of a trauma care set up over three months by undertaking three Plan-Do-Check-Act (PDCA) cycles. Materials and Methods: In the pre-intervention phase, process mapping and fish bone analysis were done to identify barriers for CVN. Barrier specific solutions were proposed, discussed and implemented. CVN rate was calculated in all phases and process improvement was measured. For the perspective of the medical technologists, a feedback form was circulated. SQUIRE guidelines were followed to write the manuscript. Statistical analysis: Descriptive data in frequency and percentages. Results: QI team achieved the goal within the time frame successfully. Rate of critical value notification improved from 2.8% in the pre-intervention phase to 68.1% in the post-intervention phase. CVN rates were highest for ICU and emergency area. Abnormal platelet count was the most commonly (42%) notified parameter. Busy telephone line was the most prominent barrier for CVN in our set up. All the medical technologists unanimously believed that CVN is a good laboratory practice, and they and their colleagues give due importance to it. Conclusions: The principles of quality improvement proved effective to improve critical value notification in a highly demanding trauma care set up. It can be further boosted with administrative and clinician support.


KEY WORDS: Decision limit, Laboratory management, Panic value, Patient safety, Process evaluation


  1. Lundberg GD. Critical (Panic) Value Notification: An Established Laboratory Practice Policy (Parameter). JAMA. 1990 Feb 2;263(5):709–709.

  2. Lippi G, Mattiuzzi C. Critical laboratory values communication: summary recommendations from available guidelines. Ann Transl Med. 2016 Oct;4(20).

  3. Valenstein PN, Wagar EA, Stankovic AK, Walsh MK, Schneider F. Notification of Critical Results: A College of American Pathologists Q-Probes Study of 121 Institutions. Arch Pathol Lab Med. 2008;132:6.

  4. Howanitz PJ, Steindel SJ, Heard NV. Laboratory critical values policies and procedures: a college of American Pathologists Q-Probes Study in 623 institutions. Archives of pathology & laboratory medicine. 2002 Jun;126(6):663-9.

  5. College of American Pathologists. Laboratory General Checklist [components GEN.130]. Available at www. cap. org. Accessed on December 2019

  6. Schneider F, Maurer C, Friedberg RC. International Organization for Standardization (ISO) 15189. Ann Lab Med]. 2017 Sep;37(5):365–70.

  7. Brown LM, Call MS, Margaret Knudson M, Cohen MJ. A Normal Platelet Count May Not Be Enough: The Impact of Admission Platelet Count on Mortality and Transfusion in Severely Injured Trauma Patients. J Trauma. 2011 Aug;71(2 0 3):S337–42.

  8. Aluru N, Samavedam S. Thrombocytopenia in Intensive Care Unit. Indian J Crit Care Med Peer-Rev Off Publ Indian Soc Crit Care Med. 2019 Sep;23(Suppl 3):S185–8.

  9. Singh H, Vij MS. Eight Recommendations for Policies for Communicating Abnormal Test Results. Jt Comm J Qual Patient Saf. 2010 May;36(5):226-AP2.

  10. Doering TA, Plapp F, Crawford JM. Establishing an Evidence Base for Critical Laboratory Value Thresholds. Am J Clin Pathol. 2014 Nov 1;142(5):617–28.

  11. Torres D de OC, Allegro L, Silva MCFC da, Monteiro Júnior JGM, Barros M das ND da S, Villachan LRR, et al. ITorres DD, Allegro L, Silva MC, MonteiroJúnior JG, Barros MD, Villachan LR, Ramos TM. Implementation, validation and review of a critical values list in a cardiac emergency room. JornalBrasileiro de Patologia e Medicina Laboratorial. 2014 Oct;50(5):332-8.

  12. Arbiol-Roca A, Corral-Comesaña S, Cano-Corres R, Castro-Castro MJ, Dastis-Arias M, Dot-Bach D. Analysis of laboratory critical values at a referral Spanish tertiary university hospital. Biochemiamedica. 2019 Feb 15;29(1):77-83.

  13. Dighe AS, Rao A, Coakley AB, Lewandrowski KB. Analysis of Laboratory Critical Value Reporting at a Large Academic Medical Center. Am J Clin Pathol. 2006 May;125(5):758–64.

 To cite this article:

Mukhopadhyay T, Subramanian A, Arya V. Critical value notification process in the hematology laboratory of a trauma care set up . Int. J. Med. Lab. Res. 2021; 6,1:11-16.

bottom of page