Laboratory Operations, quick reference 10 of 10
Calling a critical result
Who to call, what to say, read-back, documentation, and escalation
Follow your laboratory's critical-result procedure: its alert limits, authorized recipients, timing, and escalation chain. Each laboratory sets its own critical-value list.1
1. Before the call
Confirm that the result, patient identifiers, and specimen label match. Check for hemolysis, lipemia, icterus, an unexpected clot, intravenous-fluid contamination, or the wrong tube using your laboratory's specimen-acceptability and interference procedures and the test's specimen requirements.2 See guide 08: Hemolysis, lipemia, and icterus. Follow local policy on repeating the test first. If the procedure allows an urgent preliminary call, identify the result as preliminary and explain what confirmation is pending.1
2. Who receives it, and when
Call immediately when a result meets a critical value on your laboratory's list. Reach the authorized person named in your procedure, the person who ordered the test or is responsible for acting on it.4 Confirm their name before giving patient information.1
3. What to say
Give your name and laboratory. State two patient identifiers, the test, the result with its unit, and the collection date and time. Give the specimen type when it changes the meaning of the result or when the receiver asks.1,5
4. Read-back
Ask the receiver to record and read back both patient identifiers, the test, the result, and its unit. Listen to the whole read-back. Confirm it, or correct the mismatch and obtain another read-back before ending the call.5
5. What to record
Document the call as it happens.1 CMS expects the date, time, test results, and the person they were reported to.3 Also record the patient and specimen, the result's unit, your name, and that the read-back matched, as your procedure and accreditor require.1,5
6. When no one answers
Use the laboratory's escalation chain when the responsible person cannot be reached within the required time. Record every attempt, its time, the contact sought, and the outcome. Continue until the receiver confirms receipt.1
7. When the result is questioned
Explain which checks are complete, which remain pending, and what the findings support. Describe relevant specimen or method limitations.4 Arrange the next step under local policy, such as a repeat or redraw.3 Involve the supervisor or pathologist when needed.1