"Critical value" management system and critical value standard

1. Definition of "critical value".

"Critical value" means that when the results of such experiments and examinations appear, the patient may be in a life-threatening state and need to be dealt with by the clinician in a timely manner.

Second, the purpose of "critical value".

The first time to notify the clinic of the "critical value" of a certain examination or examination of a certain item of a certain patient, so as to arouse sufficient attention from medical personnel and actively take corresponding measures to ensure medical safety and maintain life safety.

3. Procedures for reporting "critical value".

(1) The "critical value" reporting procedure of the laboratory department

When the staff of the laboratory department finds the "critical value" situation, they should strictly follow the "critical value" reporting process.

In the case of confirming that there is no abnormality in the clinical and examination (test) process, verify the specimen information (including patient name, department, bed, diagnosis, testing items, etc.).

After confirming that the testing system is normal, re-test immediately, measure at the same time as the quality control specimen, and re-sample if necessary.

After the retest results are correct, for patients with "critical value" for the first time, the operator should contact the clinic in time. Notify the medical staff of the corresponding clinical department or the person in charge of the department and relevant personnel by phone within 1 minute.

The examiner should indicate on the report that "the results have been reviewed", "notified by phone" and the department, ward and name of the person who answered the call.

The registration of the "critical value" of the laboratory report requires that the patient's name, outpatient number (or hospitalization number, department, bed number), test items, test results, report time, report recipient and reporter name should be recorded in detail in the "Inspection (Check) Critical Value Report Registration Book".

The written report should be delivered to the corresponding clinical department or ward as soon as possible, and the clinical re-sampling should be notified if necessary.

If necessary, the laboratory department should keep the specimen for future reference.

(2) Procedures for reporting "critical values" in the ECG room

When the inspectors find the "critical value", they will verify the information (including the patient's name, department, bed, symptoms, test items, etc.) without the artifact, notify the person in charge of the relevant clinical department and the department of the "critical value" as soon as possible, issue a temporary diagnosis report, and re-examine if necessary to ensure the reliability and accuracy of the results. The examiner should indicate on the report that "the results have been reviewed", "notified by phone" and the department, ward and name of the person who answered the call.

If the "critical value" is inconsistent with the patient's condition, the examiner should actively communicate with the clinic in a timely manner and take further examinations to ensure the authenticity of the diagnostic results.

A detailed record of the report is made in the "Critical Value Report Register" in the ECG room.

Implement strict quality control for the items reported by the "critical value", report with a reliable way and specified time, and provide consulting services for clinical practice.

(3) Procedures for reporting "critical value" in the Department of Medical Imaging

When the inspector finds the "critical value" situation, he must first confirm whether the examination equipment is normal and whether the patient is correct, and only after confirming that there is no abnormality in the clinical and examination process can the examination results be issued.

Immediately notify the medical staff of the corresponding clinical department of the "critical value" result, verify the patient's information, and report to the person in charge of the department and relevant personnel at the same time.

Detailed records of the reports are made in the Critical Value Report Register.

Actively communicate with the clinic, provide technical advice for the clinic, and conduct further examinations if necessary to ensure the authenticity of the diagnostic results.

Fourth, the clinical department's handling process of "critical value".

(1) After receiving the "critical value" report call, if the clinician and nurse think that the result is inconsistent with the patient's clinical condition or there is a problem with the collection of specimens, they should re-collect the specimen for review, and if the result is consistent with the last time or the error is within the permitted range, they should indicate "reviewed" on the report form. (2) When the clinical department receives the "critical value" report of the laboratory department, it should keep a telephone record. Record the patient's name, outpatient number (or hospitalization number), department, bed number, time of reporting, test or test results (including recording duplicate test results), receiving time and name of the reporter in detail in the "Information Receipt Result Register". (3) The person receiving the report should report to the physician in charge in a timely manner. If the physician in charge is not available in the ward, immediately notify the department head or the senior physician in the ward. (4) After receiving the report, the physician in charge shall respond to the "critical value" report in a timely manner and take corresponding measures in light of the clinical situation. (5) When the nurse in the outpatient and emergency area receives the call of "critical value", the patient or family member should be notified in time to take the report and seek medical treatment in a timely manner. If the patient cannot be notified for a while, it should be reported to the outpatient department and the medical department in a timely manner, and the general duty should be reported during the shift. If necessary, the outpatient department should send someone to find the patient and be responsible for the implementation. (6) Within 20 minutes after receiving the "critical value" report, the physician in charge shall respond to the "critical value" report, and the doctor's order or course of illness record shall be seen, and the recipient shall be responsible for tracking the implementation and making corresponding records.

5. Updating of the "critical value" items and scope

(1) If the clinical department adds a new "critical value" item, or modifies the "critical value" due to clinical requirements, the application materials shall be submitted to the corresponding medical and technical department for revision, and shall be signed by the department director and submitted to the medical department for the record. (2) If the medical and technical department modifies the "critical value" due to work needs or clinical requirements, it shall submit an application and submit it to the medical department for the record after being signed by the department director. (3) If the standards are not uniform between departments, the medical department shall negotiate and resolve the issue.

6. Registration system

Both the "critical value" report and the receipt follow the principle of "who reports (receives), who records". All inspection, laboratory departments and clinical departments should establish a registration book of the "critical value" report of the inspection (check), and make a detailed record of the process of handling the "critical value" and related information.

7. Supervision and assessment

(1) The clinical, medical and technical departments conscientiously organize the study of the "critical value" reporting system, everyone masters the "critical value" reporting items and the scope and reporting procedures of the "critical value", and the department should have a special person responsible for the supervision of the implementation of the "critical value" reporting system in the department to ensure that the system is in place. (2) The implementation of the "critical value" reporting system. It will be included in the quality and assessment content of the department, and the medical department and other functional departments will inspect the implementation of the "critical value" reporting system of each clinical and medical technology department and the "critical value" report from the emergency department, intensive care unit, operating room and other departments where critically ill patients are concentrated, and put forward specific measures for the continuous improvement of the "critical value" reporting system.

8. Critical value items and scope

(1) If the following conditions are found in the ECG examination, a report shall be issued in a timely manner and the ward nurse and billing physician shall be contacted.

cardiac arrest

Acute myocardial ischemia

Acute myocardial infarction

Fatal arrhythmias (1) ventricular flutter, fibrillation (2) ventricular tachycardia (3) torsades de pointes (4) multisource, RonT premature ventricular contractions with prolonged Q-T interval (5) Pre-excitation syndrome with rapid ventricular rate atrial fibrillation (6) Tachycardia with ventricular rate greater than 180 beats per minute (7) Atrioventricular block with second-degree type II and above (8) Bradycardia with a heart rate of less than 40 beats per minute (9) Ventricular arrest greater than 2 seconds

(2) If the following conditions are found in the medical imaging examination, a report shall be issued in a timely manner and the ward nurse and billing physician shall be contacted.

CT, DR (1) Central nervous system 1) Acute phase of severe intracranial hematoma, contusion, subarachnoid hemorrhage 2) Acute phase of subdural/external hemorrhage 3) Cerebral herniation, acute hydrocephalus 4) Intracranial CT scan diagnosis of massive cerebral infarction (extent to one lobe or more) 5) Intracerebral hemorrhage or cerebral infarction Repeat CT examination, the degree of hemorrhage or infarction is aggravated, more than 15% compared with recent films2) Trauma to the spine and spinal cord 1) X-ray examination diagnosed as spinal fracture, long-axis angulation deformity of the spine, Comminuted vertebral fractures, compression of the dural sac, spinal cord compression, spinal fractures with angulation of the long axis of the spine 2) Multiple rib fractures with pulmonary contusion or pneumothorax. 3) Pelvic ring fracture. (3) Respiratory system 1) tracheal and bronchial foreign body 2) pneumothorax, especially tension pneumothorax (compression ratio greater than 50%) 3) pulmonary embolism and infarction 4) atelectasis on one side 5) acute pulmonary edema (4) circulatory system 1) cardiac tamponade and mediastinal swing 2) aortic dissection aneurysm 3) cardiac rupture 4) aortic vascular rupture and hemorrhage 5) tachyarrhythmia with severe hemodynamic disorder (5) digestive system 1) gastrointestinal foreign body 2) gastrointestinal perforation, intestinal paralysis, 3) Acute necrotizing pancreatitis 4) Acute cholecystitis with purulent perforation (6) Maxillofacial facial facial emergencies 1) Intraorbital foreign body 2) Intraorbital and internal prolapse, orbital fracture:

(3) If the ultrasound examination finds the following conditions, issue a report in a timely manner and contact the ward nurse and billing physician

Abdominal ultrasound examination found the following conditions, timely report and contact the ward nurse and billing physician (1), traumatic ascites effusion, for the spleen, liver or attached internal organs of the capsular hemorrhage of critical patients; (2) Purulent perforation should be considered for acute cholecystitis. (3) Consider acute necrotizing pancreatitis: (4), ruptured internal bleeding in ectopic pregnancy: (5), oligohydramnios (heart rate 180 beats/min for more than 15 minutes) in the third trimester of pregnancy :(6), signs of placental abruption in the second and third trimesters:

(7) Cardiac enlargement combined with acute heart failure (pump failure):

(8) Signs of large pericardial effusion and cardiac tamponade, large-scale myocardial infarction: (9), free thrombus found in the heart chamber, (10), aortic communication branch aneurysm formation, (11), free thrombosis of lower extremity veins.

(4) If the laboratory department finds the following situations, issue a report in a timely manner and contact the ward nurse and the billing physician

血钾1）血清钾>6.0mmol/L2）血清钾<2.8mmol/L

血钠1）血清钠>160mmol/L2）血清钠<115mmol/L

血钙1）血清钙>3.5mmol/L2）血清钙<1.5mmol/L

血糖1）血糖>30mmol/L2）血糖<2.2mmol/L

血尿素氮1）血尿素氮>36mmol/L2）血尿素氮<1.7mmol/L

血肌酐1）血肌酐>530μmol/L2）血肌酐<20μmol/L

谷丙转氨酶1)谷丙转氨酶>300U/L2)谷丙转氨酶<10U/L

1) >300U/L2) <10U/L

淀粉酶1)淀粉酶>300U/L2)淀粉酶<50U/L

总胆红素1）总胆红素>150μmol/L2）总胆红素<5μmol/L

直接胆红素1）直接胆红素>100μmol/L2）直接胆红素<2μmol/L

血气分析1）pH<7.252）pH>7.553）PO2<40mmHg4）PCO2>60mmHg5）HCO3-<15mmol/L6）HCO3->40mmol/L

Blood culture 1) positive blood culture 2) positive anaerobic culture

脑脊液1）脑脊液蛋白>2.0g/L2）脑脊液葡萄糖<1.5mmol/L3）脑脊液氯化物<90mmol/L

Others: 1) hemoglobin <50g/L2), leukocytes >30×109/L3), platelets <30×109/L4), prothrombin time >30s5), activated partial thromboplastin time >100s6), fibrinogen <1.0g/L7), D-dimer >5.0mg/L