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Shimazu C, Miyazawa Y: [Utilization of panic values in our institution: hematological testing] . Rinsho Byori. 2009 Jul;57(7):665-70.
A panic value is defined as an abnormal value indicating a life-threatening situation. Hematological examination results are sensitive to changes in treatment, and are likely to be influenced by blood collection techniques. Panic values may directly influence the diagnosis in many cases because they are treated as clinical evidence. Therefore, the reported results should be carefully evaluated considering the pathologic condition of the patient. In our institution, panic values are determined based on the following concept: "Panic values are established to determine when to ask the opinion of the physician in charge of the patient regarding the validity or confirmation of the clinical condition when an abnormal value is observed." This report describes our approaches for the utilization of panic values and associated problems. Values were determined by referring to those reported previously in the literature and considering differences between the former panic values and clinical conditions and the prescription history of the patients. The reports were made to the doctors in charge in each of the departments directly by telephone or pager. Clinical technologists obtained clinical information, such as on the diagnosis, infusion solutions, and medications, and asked for approval to conduct additional examinations accordingly. The numbers of reports on each item for six months from March to August in 2008 were summed. As the results, a total of four items (SFMC + TAT + D-d + FDP) accounted for 28%, hemoglobin 15%, platelets 10%, INR 9%, APTT 8%, two or more items of CBC 8%, PT+APTT 7%, differential WBC 6%, CBC + differential WBC 5%, WBC 3%, fibrinogen 0.9%, and AT 0.1%. The number of reports as a percentage of the total orders was 0.14% for CBC-related and 0.49% for hemostasis-related items. Regarding diseases and clinical conditions, blood collection-related events accounted for 11.9%, poor management of warfarin administration 9.3%, leukemia and malignant lymphoma 7.7% and chemotherapy 7.4%, and then under-administration of heparin, DIC, the perinatal period, gastrointestinal hemorrhage, severe hepatic disorder, EBV, and acute virus infection, in order of decreasing frequency. This method enabled the quick and accurate reporting of panic values to clinical sites. Furthermore, clinical technologists could be motivated to increase their awareness of the value of examinations, medications, and treatments and to be more involved in medical practice. However, there were some problems, such as intervening in the clinical practice of physicians in charge, individual variations in the performance level of clinical technologists, and insufficient uniformity of management and calculation of panic values. The provision of clinically useful information will be made possible by constructing systems to send panic values to the mobile terminals of physicians in charge and being able to refer to the results and manage medical records on the system when electronic medical charts begin to be used next year. |
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