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Medicina & Laboratorio

2011, Número 07-08

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Medicina & Laboratorio 2011; 17 (07-08)


Valores críticos en el laboratorio clínico: de la teoría a la práctica

Campuzano MG

Idioma: Español
Referencias bibliográficas: 66
Paginas: 331-350
Archivo PDF: 641.28 Kb.


RESUMEN

Independiente del motivo por el cual el médico solicita una prueba de diagnóstico, al final del proceso, el laboratorio clínico genera un informe escrito que entrega al paciente en los laboratorios clínicos ambulatorios o incorpora a la historia clínica en los laboratorios clínicos hospitalarios. Los valores críticos, también conocidos como valores de alarma, mal denominados valores de pánico, son los resultados de pruebas de diagnóstico que expresan una situación médica que puede poner en riesgo la vida del paciente si no se interviene adecuada y oportunamente, de ahí la importancia de que se informen al médico que ha solicitado la prueba, inmediatamente se identifiquen. La política y manejo de los valores críticos es un requisito obligatorio en los laboratorios clínicos de los países desarrollados y hace parte de procesos de acreditación o de calidad en los países en vía de desarrollo, como sucede en Colombia, desafortunadamente muy pobremente desarrollado en los laboratorios clínicos del país. Una vez que el laboratorio clínico opta por establecer un programa de valores críticos, debe instaurar claramente una política de valores críticos, la lista de exámenes con sus respectivos valores críticos, los mecanismos y las personas responsables de notificar los valores críticos cuando éstos se presentan; además de que deberá implementar mecanismos internos que le permitan evaluar y hacer seguimiento de la política de valores críticos, como un mecanismo de mejoramiento continuo. En este módulo se presentan los elementos indispensables para establecer un programa de valores críticos en el laboratorio clínico, independiente de su nivel de complejidad y ubicación, ya sea ambulatorio u hospitalario. La política de valores críticos, más que una norma o una herramienta de mejoramiento continúo en el laboratorio clínico: es un derecho de los pacientes.


REFERENCIAS (EN ESTE ARTÍCULO)

  1. Silverstein MD. An approach to medical errors and patient safety in laboratory sciences. A white paper. Qualite Institute Conference. Atlanta. April 13-15. 2003;1-23.

  2. Campuzano-Maya G. Papel del laboratorio clínico en la práctica médica. Laboratorio al Día 1995;5:22-27.

  3. Plebani M. Laboratory medicine: value for patients is the goal. Clinical chemistry 2007;53:1873-1874.

  4. Price CP. Roots, development and future directions of laboratory medicine. Clinical chemistry and laboratory medicine : CCLM / FESCC 2010;48:903-909.

  5. Laposata M, Proytcheva MA, Rutledge JC, Stratton CW. Professional quality assurance in laboratory medicine: what about the competency of laboratory directors? American journal of clinical pathology 2010;134:706-708.

  6. Arya SC, Hernandez JS, Dale JC, Bennet KE, Varkey P. Challenges and opportunities for medical directors in pathology and laboratory medicine: standardization, integration, and innovation. American journal of clinical pathology 2010;133:819-820.

  7. Eisenberg JM. The Agency for Healthcare Research and Quality: new challenges, new opportunities. Health services research 2000;35:xi-xvi.

  8. Lundberg G. When to panic over an abnormal value. Med Lab Obs 1972;4:47-54.

  9. Tillman J, Barth JH. A survey of laboratory ‘critical (alert) limits’ in the UK. Annals of clinical biochemistry 2003;40:181-184.

  10. Wagar EA, Stankovic AK, Wilkinson DS, Walsh M, Souers RJ. Assessment monitoring of laboratory critical values: a College of American Pathologists Q-Tracks study of 180 institutions. Archives of pathology & laboratory medicine 2007;131:44-49.

  11. 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. Archives of pathology & laboratory medicine 2008;132:1862-1867.

  12. Hanna D, Griswold P, Leape LL, Bates DW. Communicating critical test results: safe practice recommendations. Joint Commission journal on quality and patient safety / Joint Commission Resources 2005;31:68-80.

  13. Dighe AS, Rao A, Coakley AB, Lewandrowski KB. Analysis of laboratory critical value reporting at a large academic medical center. American journal of clinical pathology 2006;125:758-764.

  14. Mireskandari M. How do surgical pathologists evaluate critical diagnoses (critical values)? Diagnostic pathology 2008;3:30.

  15. Organización Mundial de la Salud (OMS). Marco Conceptual de la Clasificación Internacional para la Seguridad del Paciente. Informe técnico definitivo. 2009. Disponible en: http://www.who.int/patientsafety/implementation/icps/icps/full/report/es.pdf. Accesado en agosto 31 de 2011.

  16. Catrou PG. How critical are critical values? American journal of clinical pathology 1997;108:245-246. 17. Emancipator K. Critical values: ASCP practice parameter. American Society of Clinical Pathologists. American journal of clinical pathology 1997;108:247-253.

  17. Weber LJ, Bissell MG. Reporting panic values in the middle of the night. Clinical laboratory management review : official publication of the Clinical Laboratory Management Association / CLMA 1997;11:52-53.

  18. Lum G. Critical limits (alert values) for physician notification: universal or medical center specific limits? Annals of clinical and laboratory science 1998;28:261-271.

  19. Wagar EA, Friedberg RC, Souers R, Stankovic AK. Critical values comparison: a College of American Pathologists Q-Probes survey of 163 clinical laboratories. Archives of pathology & laboratory medicine 2007;131:1769-1775.

  20. Hortin GL, Csako G. Critical values, panic values, or alert values? American journal of clinical pathology 1998;109:496-498.

  21. Joint Commission on Accreditation of Healthcare Organizations (JCAHO) National Patient Safety Goals. 2004. Disponible en: http://www.jointcommission.org/NR/rdonlyres/F04D6D9C-7EB8-46D2-B2E5-98E4A33F193E/0/08_LAB_NPSGs_Master.pdf. Accesado en agosto 31 de 2011.

  22. International Organization for Standardization. ISO15189:2007: Medical laboratories: Particular requirements for quality and competence. Geneva, Switzerland. 2007.

  23. Clinical Laboratory Improvement Amendments (CLIA). CLIA Regulations and Federal Register Documents. CLIA Regulations Part 493 (CDCsite). 2004. Disponible en: http://wwwn.cdc.gov/clia/regs/subpart_k.aspx#493.1291. Accesado en agosto 31 de 2011.

  24. LiVolsi VA. Critical values in anatomic pathology: how do we communicate? American journal of clinical pathology 2004;122:171-172.

  25. LiVolsi VA, Leung S. Communicating critical values in anatomic pathology. Archives of pathology & laboratory medicine 2006;130:641-644.

  26. Coffin CM, Spilker K, Lowichik A, Zhou H, Nielson K, Erickson L, et al. Critical values in pediatric surgical pathology: definition, implementation, and reporting in a children’s hospital. American journal of clinical pathology 2007;128:1035-1040.

  27. Pereira TC, Silverman JF, LiVolsi V, Fletcher CD, Frable WJ, Goldblum JR, et al. A multi-institutional survey of critical diagnoses (critical values) in surgical pathology and cytology. American journal of clinical pathology 2008;130:731-735.

  28. Genzen JR, Tormey CA. Pathology consultation on reporting of critical values. American journal of clinical pathology 2011;135:505-513.

  29. Pereira TC, Clayton AC, Tazelaar HD, Liu Y, Leon M, Silverman JF. Critical values in cytology. Diagnostic cytopathology 2006;34:447-451.

  30. Chapman CN, Otis CN. From critical values to critical diagnoses: A review with an emphasis on cytopathology. Cancer cytopathology 2011;119:148-157.

  31. Lakhani P, Langlotz CP. Documentation of nonroutine communications of critical or significant radiology results: a multiyear experience at a tertiary hospital. Journal of the American College of Radiology : JACR 2010;7:782-790.

  32. Hussain S. Communicating critical results in radiology. Journal of the American College of Radiology : JACR 2010;7:148-151.

  33. Lakhani P, Langlotz CP. Automated detection of radiology reports that document non-routine communication of critical or significant results. Journal of digital imaging: the official journal of the Society for Computer Applications in Radiology 2010;23:647-657.

  34. Towbin AJ, Hall S, Moskovitz J, Johnson ND, Donnelly LF. Creating a comprehensive customer service program to help convey critical and acute results of radiology studies. AJR. American journal of roentgenology 2011;196:W48-51.

  35. Howanitz JH, Howanitz PJ. Evaluation of total serum calcium critical values. Archives of pathology & laboratory medicine 2006;130:828-830.

  36. Ricos C, Cava F, Garcia-Lario JV, Hernandez A, Iglesias N, Jimenez CV, et al. The reference change value: a proposal to interpret laboratory reports in serial testing based on biological variation. Scandinavian journal of clinical and laboratory investigation 2004;64:175-184.

  37. College of American Pathologist (CAP). Commission on Laboratory Accreditation. 2011. Disponible en:http://www.cap.org/apps/cap.portal. Accesado en agosto 31 de 2011.

  38. Statland BE. Clinical decision levels for laboratory tests. Oradell NJ: Medical Economics Books, 1987.

  39. John R, Lifshitz MS, Jhang J, Fink D. Post-analysis: Medical decison-making In: Henry´s. Clinical diagnosis and management by laboratory methods, edited by McPherson RA, Pincus MR. Philadelphia: Saunders, Elsevier, 2007, p. 68-75.

  40. Lum G. Evaluation of a laboratory critical limit (alert value) policy for hypercalcemia. Archives of pathology & laboratory medicine 1996;120:633-636.

  41. Instituto Colombiano de Normas Técnicas y Normalización (Icontec). NTC-ISO 15189. Laboratorios clínicos. Requisitos particulares relativos a la calidad y la competencia. Bogotá, Colombia. 2007.

  42. República de Colombia, Ministerio de la Protección Social. Decreto número 1011 de 2006 (3 de abril 2006). Por el cual se establece el Sistema Obligatorio de Garantía de Calidad de la Atención de Salud del Sistema General de Seguridad Social en Salud.

  43. República de Colombia, Ministerio de la Protección Social. Resolución número 1445 de 2006 (8 de mayo 2006). Por la cual se definen las funciones de la entidad acreditadora y se adoptan otras disposiciones.

  44. Instituto Colombiano de Normas Técnicas y Normalización (Icontec). Guía Técnica Colombiana GTC-135 para la evaluación de la conformidad de los requisitos particulares para calidad y competencia en los laboratorios clínicos de acuerdo con la NTC 5420:2004 (ISO 15189:2003). Bogotá, Colombia. 2006.

  45. 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;126:663-669.

  46. Chassin MR, Galvin RW. The urgent need to improve health care quality. Institute of Medicine National Roundtable on Health Care Quality. JAMA : the journal of the American Medical Association 1998;280:1000-1005.

  47. Tan CK, Lai CC, Lin JJ, Kuo YW, Lin HJ. Not all critical laboratory values are equally urgent to physicians. BMJ quality & safety 2011;20:201-202.

  48. Don-Wauchope AC, Chetty VT. Laboratory defined critical value limits: how do hospital physicians perceive laboratory based critical values? Clinical biochemistry 2009;42:766-770.

  49. Kost GJ. Clinical and professional reference guides. Table of critical limits. MLO: medical laboratory observer 2001;33:12-13.

  50. Haverstick DM. Critical value called, read-back obtained. American journal of clinical pathology 2004;121:790-791.

  51. Jenkins JJ, Mac Crawford J, Bissell MG. Studying critical values: adverse event identification following a critical laboratory values study at the Ohio State University Medical Center. American journal of clinical pathology 2007;128:604-609.

  52. Lippi G, Giavarina D, Montagnana M, Luca Salvagno G, Cappelletti P, Plebani M, et al. National survey on critical values reporting in a cohort of Italian laboratories. Clinical chemistry and laboratory medicine: CCLM/FESCC 2007;45:1411-1413.

  53. Piva E, Plebani M. Interpretative reports and critical values. Clinica chimica acta; international journal of clinical chemistry 2009;404:52-58.

  54. Etchells E, Adhikari NK, Cheung C, Fowler R, Kiss A, Quan S, et al. Real-time clinical alerting: effect of an automated paging system on response time to critical laboratory values--a randomised controlled trial. Quality & safety in health care 2010;19:99-102.

  55. Parl FF, O’Leary MF, Kaiser AB, Paulett JM, Statnikova K, Shultz EK. Implementation of a closed-loop reporting system for critical values and clinical communication in compliance with goals of the joint commission. Clinical chemistry 2010;56:417-423.

  56. Kost GJ, Hale KN. Global trends in critical values practices and their harmonization. Clinical chemistry and laboratory medicine : CCLM / FESCC 2011;49:167-176.

  57. Piva E, Sciacovelli L, Zaninotto M, Laposata M, Plebani M. Evaluation of effectiveness of a computerized notification system for reporting critical values. American journal of clinical pathology 2009;131:432-441.

  58. Kost GJ. Table of critical limits. MLO: medical laboratory observer 2004;36:6-7.

  59. Kost GJ. Table of critical limits. MLO: medical laboratory observer 2007;39:6-7.

  60. Dighe AS, Jones JB, Parham S, Lewandrowski KB. Survey of critical value reporting and reduction of falsepositive critical value results. Archives of pathology & laboratory medicine 2008;132:1666-1671.

  61. Bates DW, Pappius E, Kuperman GJ, Sittig D, Burstin H, Fairchild D, et al. Using information systems to measure and improve quality. International journal of medical informatics 1999;53:115-124.

  62. Laboratorio Clínico Hematológico. Sistema Integrado de Gestión (ISO 9001, ISO 14001, ISO 18001). Manual de Procedimientos. Medellín, Colombia

  63. Ottomano C. Errors in medicine and errors in laboratory medicine: what is the difference? Blood transfusion= Trasfusione del sangue 2010;8:79-81.

  64. Barenfanger J, Sautter RL, Lang DL, Collins SM, Hacek DM, Peterson LR. Improving patient safety by repeating (read-back) telephone reports of critical information. American journal of clinical pathology 2004;121:801-803.

  65. Win KT. A review of security of electronic health records. The HIM journal 2005;34:13-18.

  66. Burk B, Cllahan C. Health information privacy and patient safety: A delicate balance. Hospital News 2008;33.




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