It Is Time to Extend the Laboratory Critical (Panic) Value System to Include Vital Values

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A critical (or panic) laboratory value is a laboratory test result that represents a pathophysiologic state at such variance with normal as to be life-threatening if an action is not taken quickly and for which an effective action is possible. We at the Los Angeles County-USC Medical Center are widely credited with having first created and implemented a critical value system in 1971.[1]

Although not initially published in a peer-reviewed journal, recognition of the commonsense usefulness of such a concept leads to its rapid acceptance and widespread implementation in a very short time. The original multicolored, centerfold pullout chart was quickly posted in labs throughout America. The system requires that a lab person recognize the critical value and, after verification, take aggressive responsibility for finding a clinician who will make sure an action is taken. The Critical Values system was soon institutionalized into accreditation requirements.[2] We always intended that each medical staff should determine which lab tests have critical limits and what they are, because different institutions may panic at different levels. Although this system is labor-intensive and some hospital workers may get upset when called, it continues to be required and useful.[3] We also conceived the logical extension, the vital value, 30 years ago, but never published or formally implemented it. A vital value is a laboratory result just as important as a critical value, but one for which timing is not as crucial. While a blood glucose under 40 mg/dL is a critical value, positive Pap smears, mammograms, or TB cultures are examples of vital values. Labs and quality control units everywhere should define their vital values and design and implement systems that will parallel the Critical Value system. That's my opinion. I'm Dr. George Lundberg, Editor-in-Chief of MedGenMed.