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Releasing, calling and correcting results

15 min

  • Choose release, repeat, comment, or recollection from the specimen checks and QC
  • Communicate a critical result with identifiers, units, and confirmed receipt
  • Call an established critical result before continuing routine work
  • Correct a reported error, keep both reports, and notify the care team

Read the full reference

Try first

TestResultPreviousReference intervalFlag
Sodium144 mmol/L139 mmol/LYesterday 06:00135–145 mmol/L
Potassium2.9 mmol/L4.1 mmol/LYesterday 06:003.5–5.1 mmol/LLow
Chloride119 mmol/L104 mmol/LYesterday 06:0098–107 mmol/LHigh

Specimen: H 8, L 10, I 1. Serum, drawn from the left arm; saline infusing in the left forearm

Try first

An inpatient's basic metabolic panel was drawn from the arm with normal saline infusing above the site. QC for the run is acceptable, and the hemolysis index is low. What do you do with the panel?

The next section explains it.

Right. The next section explains why.

The next section explains it.

The next section explains it.

The next section explains it.

Get the idea

Four checks before release

A result leaves the laboratory only after four checks agree:

  • the specimen belongs to the patient
  • the specimen is fit for the test
  • the run was in control
  • the result makes sense beside the patient's history

Each check covers something the others cannot. Acceptable QC shows the analyzer measured its control material correctly. It cannot detect infusion fluid, carryover or hemolysis in one patient's tube.1,2

The checks lead to one of five dispositions:

DispositionWhen
ReleaseIdentity, specimen, run and history all check out
RepeatThe doubt is in the measurement, and the specimen is suitable
Release with a commentThe procedure allows the result with a stated limitation
Keep pending release with a commentA check is still open, such as identity or a question to the ward
RedrawThe specimen itself is wrong: contamination, hemolysis from the draw above the limit, a clot, the wrong tube

Critical results come first

When a result meets a value on the laboratory's critical list, the laboratory alerts the person responsible for the patient at once. Routine verification waits, and so does any repeat the procedure does not require.2,3

On the call:4,5

  1. Identify yourself and the person receiving the result.
  2. Give two patient identifiers, the test, and the value with its unit.
  3. When the procedure calls for read-back, listen to the whole of it. Correct any mismatch in the identifier, value or unit before ending the call.

The record shows the date and time, the result and the person notified. If the first contact cannot be reached, the escalation list in the procedure is followed until someone authorized accepts the result.3,6

Correct a reported error in the open

When the laboratory finds an error in a result already reported, it:2,6

  • promptly notifies the person who ordered the test
  • promptly issues a corrected report
  • keeps both the original and the corrected report

Clinicians may already have acted on the first value, so the report shows that it was corrected, and the original stays traceable.2,6

References
  1. Krasowski MD. Educational case: hemolysis and lipemia interference with laboratory testing. Acad Pathol. 2019;6:2374289519888754. doi:10.1177/2374289519888754
  2. Centers for Medicare & Medicaid Services. 42 CFR §§493.1256 and 493.1291. Electronic Code of Federal Regulations. Accessed September 23, 2026.
  3. Clinical and Laboratory Standards Institute. Management of Critical- and Significant-Risk Results. 1st ed. CLSI guideline GP47. Clinical and Laboratory Standards Institute; 2015. Accessed September 23, 2026.
  4. Henriksen K, Hall KK. Say it again. PSNet. Agency for Healthcare Research and Quality. Published June 1, 2011. Accessed September 23, 2026.
  5. College of American Pathologists. Laboratory General Checklist. COM.30000, COM.30100. June 4, 2020. Accessed September 23, 2026.
  6. Centers for Medicare & Medicaid Services. State Operations Manual, Appendix C: Survey Procedures and Interpretive Guidelines for Laboratories and Laboratory Services. Updated January 23, 2026. Accessed September 23, 2026.

Watch one

You are verifying a batch of 40 routine outpatient chemistries when an emergency department potassium comes up at 6.8 mmol/L.

  • The hemolysis index is 20, and your procedure's potassium limit is 50.
  • The label matches the order with both identifiers, and QC is acceptable.
  • Your laboratory's critical limit for potassium is 6.2 mmol/L or above, and the procedure calls without a repeat.

What do you do?

  1. Check the specimen: the index of 20 is below the potassium limit of 50, identity matches, and QC is acceptable.

    A critical call on a flawed specimen sends the care team after an artifact, so the quick specimen checks come first.

  2. Compare with the critical list: 6.8 mmol/L is at or above 6.2 mmol/L, so the result is critical.

    The critical list decides whether the result needs an immediate call.

  3. Stop the batch: the 40 routine results wait until the call is done.

    Minutes matter for a critical potassium, and routine turnaround can absorb the pause.

  4. Call the emergency department: give your name, confirm the receiver's name, then two identifiers, potassium and 6.8 mmol/L.

    Two identifiers link the result to one patient, and the unit keeps the number from being misread.

  5. Take the read-back, confirm it matches, and record the date, time, result and receiver before returning to the batch.

    The read-back shows what the receiver wrote down, and the record shows the call was made in time.

Call the critical potassium of 6.8 mmol/L now, document it, then finish the routine batch.

Your turn

Problem 1 of 3

An error is found in a patient result that has already been reported. Which response meets the reporting requirement?

Correct. Under 42 CFR 493.1291(k), the laboratory promptly notifies the person who ordered the test, promptly issues a corrected report, and keeps both the original and the corrected report.

Incorrect. Notification is required, but overwriting erases the value that clinicians may already have acted on. Keep the original report beside the corrected one.

Incorrect. Notify the person who ordered the test promptly, because a routine report can arrive after someone has acted on the wrong value.

Hint
  1. Someone may already have acted on the first value.
  2. The requirement has three parts: who is told, what is issued and what is kept.
  3. Look for the answer that leaves a trace of the original.

Review Analytic and postanalytic safeguards

Problem 2 of 3

You call a critical potassium of 6.8 mmol/L for the patient with MRN 0318204. The nurse reads back: "0318240, potassium 6.8 millimoles per liter." What do you do?

The last two digits are swapped, so the nurse has written the result against another number. Correct it and hear a read-back that matches before ending the call.

The MRN read back is 0318240, and the patient is 0318204. Ending the call now leaves the result written against the wrong number.

Accepted an incorrect read-back

When the procedure requires read-back of a verbal report, the read-back shows what the caregiver wrote down. Ending the call with a mismatch in the patient, value, or unit leaves the care team acting on a wrong result. The record keeps the date, time, result, and person notified.

The nurse is a receiver named in the procedure, and the mismatch can be fixed on this call. Starting over delays a critical result.

Hint
  1. Compare every part of the read-back with what you said.
  2. Check the identifier as well as the value and unit.

Review Analytic and postanalytic safeguards

Problem 3 of 3

During the morning run you verify a glucose of 38 mg/dL from a ward patient. Your laboratory's critical list includes glucose of 50 mg/dL or below, and the procedure requires no repeat for it. Twelve routine results are waiting to be verified in the batch. What do you do?

The procedure does not require a repeat, and one adds minutes before the ward learns of a critical result.

A glucose of 38 mg/dL is on the critical list, so the call comes first. The twelve routine results can wait a few minutes.

Finishing the batch first leaves the care team without a critical glucose for that time. Routine work waits for the call.

Delayed a critical call for routine work

A result that meets the laboratory's critical criteria is called at once to the person who ordered the test. Routine work, and any repeat the procedure does not require, waits. Finishing the batch first leaves the care team without a life-threatening result for that time.

Review Analytic and postanalytic safeguards

Use it

  • An adult man, 0318204, in the emergency department has a basic metabolic panel.
  • The label carries his name and MRN, matching the order.
  • The department confirms he was drawn at 14:05 from an arm with no infusion.
  • The hemolysis index is 15, below the potassium limit of 50, and QC is acceptable.
  • Potassium, BUN and creatinine fail the delta check against his clinic panel from 2 days ago.
  • Your laboratory's critical limit for potassium is 6.2 mmol/L or above, and the procedure calls without a repeat.
  • Twenty-five routine results are waiting in your queue.
TestResultPreviousReference intervalFlag
Sodium136 mmol/L138 mmol/L2 days ago135–145 mmol/L
Potassium6.9 mmol/L4.4 mmol/L2 days ago3.5–5.1 mmol/LCritical
Chloride101 mmol/L103 mmol/L2 days ago98–107 mmol/L
BUN58 mg/dL22 mg/dL2 days ago8–24 mg/dLHigh
Creatinine3.10 mg/dL1.20 mg/dL2 days ago0.74–1.35 mg/dLHigh

Specimen: H 15, L 10, I 1. Serum, drawn at 14:05; no infusion in the drawing arm

Decision 1 of 3

The potassium failed the delta check. What do you do with it?

The checks a delta needs are done: identity is confirmed, no infusion was in the arm, the index is low and QC is acceptable. Waiting for a redraw would delay a critical result.

Nothing points to a flawed specimen. A redraw adds an hour before the care team hears about a critical potassium.

Identity, collection site, hemolysis and QC all check out, and BUN and creatinine moved in the same direction over the same 2 days. The change fits the patient, so the potassium is released and called.

Review Specimen integrity and interference

Decision 2 of 3

What comes next?

Every minute spent on the routine queue is a minute the care team goes without a potassium of 6.9 mmol/L. The critical call comes first.

Delayed a critical call for routine work

A result that meets the laboratory's critical criteria is called at once to the person who ordered the test. Routine work, and any repeat the procedure does not require, waits. Finishing the batch first leaves the care team without a life-threatening result for that time.

A potassium of 6.9 mmol/L is above the critical limit of 6.2 mmol/L, and the procedure calls without a repeat. The call comes before the routine queue.

The procedure calls without a repeat, and the specimen checks are already done. A repeat only delays the call.

Review Analytic and postanalytic safeguards

Decision 3 of 3

The emergency department nurse answers. What do you give?

A name is one identifier, and two patients can share it. The MRN or date of birth, and the unit, are needed too.

Matched a result to a patient by name alone

A name is one identifier, and two patients can share it. Giving or filing a result after matching the name alone can place one patient's value in another's record or give a caregiver the wrong result. Two person-specific identifiers, such as name with date of birth or medical record number, link a specimen to one patient.

Name and MRN tie the result to one patient, and the unit keeps the number from being misread. The read-back shows what the nurse wrote down, and the call is recorded with the time and the nurse's name.

Without identifiers from you, the nurse could attach the result to the wrong patient. Give two identifiers on the call.

Review Analytic and postanalytic safeguards

The clue that settles it is that every check behind the delta passed and the other results moved with the potassium:

  • Identity was confirmed.
  • No infusion was in the arm.
  • The index was low, and QC was acceptable.
  • BUN and creatinine rose over the same 2 days.

With the specimen cleared, the result is critical, and the call comes before the routine queue.

Keep