The Call

You are covering the chemistry bench.

Four shifts. Each one starts with the phone ringing and ends when the report, the calls, and the notes are done. The card at the top tells you what to do next; open "If you're stuck" when you need it.

Pick a shift
Settings

For instructors
The shifts

Four guided chemistry shifts, about 25 to 35 minutes each. Every shift starts with the floor calling about a critical on hold and ends when the report, the calls, and the notes are done. The troubleshooting is the same every time; what the checks turn up is not. The picker never names the cause; the debrief does.

  1. Two ED patients drawn back to back, labels switched at the cart.
  2. Morning labs drawn above a running IV.
  3. ICU line draw, lavender filled first, EDTA in the gold top.
  4. Nothing wrong. The rerun holds, the 2-hour climbs, the result stands.

Assignment text:

Work all four shifts in order. Answer the phone, find the patient, give the critical the way our procedure says, and stay on the case until the report, the calls, and the notes are done. Bring each debrief to the discussion.
What the debrief shows
The clock for every action, everything opened and checked, every statement and whether the notes backed it up at the time, scores by domain, safety-critical findings with the Library page to review, and any replay. Nothing is stored after the page is reloaded.
Sources

Patients, callers, results, extensions, and lab procedures are written for these shifts; the instrument records are authored, not the manufacturer's. The causes are common preanalytical findings and, on shift 4, a genuine rising troponin.1,5 The identification, read-back, critical-value, and corrected-report rules in the procedures binder follow the two-identifier requirement, closed-loop check-back, and the test-report standard.2,3,4

Shift 2 uses a synthetic admixture of blood and potassium-containing dextrose fluid; its electrolyte direction follows the listed fluid composition.6

In Shift 3, the panel prompts investigation; collection review confirms the tube transfer. A normal ECG cannot exclude hyperkalemia.7,8

Related reading:Ordering, identification, and acceptability,Specimen integrity and interference,Analytic and postanalytic safeguards,Cardiac troponin: interferences and serial testing.

References

  1. Lippi G, von Meyer A, Cadamuro J, Simundic AM. Blood sample quality. Diagnosis (Berl). 2019;6(1):25-31.
  2. The Joint Commission. Two patient identifiers: understanding the requirements. Standards FAQ.
  3. Agency for Healthcare Research and Quality. TeamSTEPPS tool: check-back (or repeat-back).
  4. 42 CFR 493.1291, Standard: test report. Electronic Code of Federal Regulations.
  5. Fifth Universal Definition of Myocardial Infarction (2026). Global Heart.
  6. DailyMed. Potassium chloride in dextrose and sodium chloride injection. Composition of 20 mEq/L potassium chloride in 5% dextrose and 0.45% sodium chloride.
  7. Cornes MP, Ford C, Gama R. Spurious hyperkalaemia due to EDTA contamination: common and not always easy to identify. Ann Clin Biochem. 2008;45:601-603.
  8. Clinical and electrocardiogram presentations of patients with high serum potassium concentrations within emergency settings: a prospective study. 2022.