Beth Israel Deaconess Medical Center
Laboratory Manual

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Urgent Tests

Urgent laboratory values are test results that are outside normal limits, and that have significant medical implications for the patient requiring attention and action by the patient’s providers.  A list of tests for which urgent values exist, and the urgent values themselves, has been established by the BIDMC clinical laboratory, and are, annually, reviewed, with modifications as needed, and approved by the Core Clinical Services Committee (CCSC). 

The urgent value list:

Lab
 Section
 Non-critical values called
 Explanation for Decision to Call Critical Values/Results
Anatomic Pathology
Physicians will email clinicians if the cytology is positive for both gyn and non gyn specimens 
 Regulatory requirement (CAP)  


Any diagnosis of malignancy in an uncommon location or specimen type (ie, hernia sac, tonsil intervertebral disc material), or unexpected clinical situation 
 Regulatory requirement (CAP)  


Any definitive diagnosis of specific infection or other severe medical condition requiring immediate therapy (ie., temporal arteritis)
 Regulatory requirement (CAP)  


Pathology reports are sometimes called if requested as a rush case (ie transplant cases) 
 Regulatory requirement (CAP)  


Absence of chorionic villi when clinically expected    Regulatory requirement (CAP)
 Regulatory requirement (CAP)  


Any significant discrepancy between the permanent section and frozen section diagnoses 
 Regulatory requirement (CAP)  
Chemistry  
Newly positive HIV test result (following confirmation by Western  Blot Analysis)
 Regulatory requirement (CAP)
Microbiology
 Stool Culture Bench 
 Salmonella 
 Public Health Concern  


Shigella  
 Public Health Concern  


Campylobacter
 Public Health Concern  


Yersinia 
 Public Health Concern  


Vibrio 
 Public Health Concern  

Respiratory Culture Bench
 Legionella 
 Public Health Concern  

Genital Culture Bench
 Neisseria gonorrhoeae (GC) and Chlamydia trachomatis
 Public Health Concern  

Blood Culture Bench
 Salmonella and other stool pathogens
 Public Health Concern  


Brucella 
 Public Health/CDC select agent 


Francisella tularensis  
 Public Health/CDC select agent 


Neisseria gonorrhoeae 
 Public Health/CDC select agent 


Neisseria meningitidis 
 Public Health/CDC select agent 

Mycology Culture Bench
 Histoplasma
 Extensive delay between specimen acquisition and final result  


Coccidioides
 Extensive delay between specimen acquisition and final result   


Blastomyces 
 Extensive delay between specimen acquisition and final result   


Paracoccidioides 
 Extensive delay between specimen acquisition and final result   


Cryptococcus neoformans (Respiratory sources)
 Extensive delay between specimen acquisition and final result   

Virology Lab
 Positive DFA for HSV/VZV  
 Contact precautions for inpatients 


Positive CMV Early Antigen 
 Might require therapeutic intervention 

Molecular Lab 
 Positive Chlamydia PCR 
 Public Health Concern  


Positive Neisseria gonorrhoeae (GC)
 Public Health Concern  


Positive HIV Viral Load acute infection 
 Public Health Concern  

All areas
 Other results (Select agents, etc.) on daily rounds that may be considered significant or unusual 
 Infection Control and ID called with id re type of  resistance 
Send-outs  
Abnormal maternal screening results 
 Rapid delivery for decision  making  
Cytogenetics
Abnormal prenatal (amniotic fluid or chorionic villlus) result
Abnormal results in certain bone marrow cases
New diagnoses of APMLs and other malignancies, and in certain instances of relapse in patients
 Extensive delay between specimen acquisition and final result   

Revised/Reviewed 2/18/2009

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