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Clinical Chemistry and Laboratory Medicine (CCLM)

Published in Association with the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM)

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Volume 56, Issue 3


Reaching consensus on communication of critical laboratory results using a collective intelligence method

Maria Isabel Llovet
  • Corresponding author
  • Medical Laboratory ICS Terres de l’Ebre, Hospital Verge de la Cinta, C/Esplanetes, 14, 43500 Tortosa, Spain
  • Email
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Carmen Biosca / Alicia Martínez-Iribarren / Aurora Blanco / Glòria Busquets / María José Castro / Maria Antonia Llopis / Mercè Montesinos / Joana Minchinela / Carme Perich / Judith Prieto / Rosa Ruiz / Núria Serrat / Margarita Simón
  • Medical Laboratory Consorci Intercomarcal Anoia, Penedès i Garraf (CLI), Vilafranca del Penedes, Spain
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Alex Trejo / Josep Maria Monguet / Carlos López-Pablo / Mercè Ibarz
Published Online: 2017-10-23 | DOI: https://doi.org/10.1515/cclm-2017-0374



There is no consensus in the literature about what analytes or values should be informed as critical results and how they should be communicated. The main aim of this project is to establish consensual standards of critical results for the laboratories participating in the study. Among the project’s secondary objectives, establishing consensual procedures for communication can be highlighted.


Consensus was reached among all participating laboratories establishing the basis for the construction of the initial model put forward for consensus in conjunction with the clinicians. A real-time Delphi, methodology “health consensus” (HC), with motivating and participative questions was applied. The physician was expected to choose a numeric value within a scale designed for each analyte.


The medians of critical results obtained represent the consensus on critical results for outpatient and inpatient care. Both in primary care and in hospital care a high degree of consensus was observed for critical values proposed in the analysis of creatinine, digoxin, phosphorus, glucose, international normalized ratio (INR), leukocytes, magnesium, neutrophils, chloride, sodium, calcium and lithium. For the rest of critical results the degree of consensus obtained was “medium high”. The results obtained showed that in 72% of cases the consensual critical value coincided with the medians initially proposed by the laboratories.


The real-time Delphi has allowed obtaining consensual standards for communication of critical results among the laboratories participating in the study, which can serve as a basis for other organizations.

This article offers supplementary material which is provided at the end of the article.

Keywords: benchmarking; clinical laboratory; consensus on critical values; critical results; Delphi; health consensus


  • 1.

    Lundberg G. When to panic over an abnormal value. Med Lab Obs 1972;4:47–54.Google Scholar

  • 2.

    International Organization for Standardization (ISO). ISO 15189:2012: medical laboratories. Requirements for quality and competence. Geneva: ISO.Google Scholar

  • 3.

    Joint Commission on Accreditation of Healthcare Organization (JCAHO); Laboratory Services: National Patient Safety Goals. 2013. http://www.jointcommission.org.

  • 4.

    Hashim IA, Cuthbert JA. Establishing, harmonizing and analyzing critical values in a large academic health center. Clin Chem Lab Med 2014;52:1129–35.Web of ScienceGoogle Scholar

  • 5.

    Campbell CA, Horvath AR. Harmonization of critical result management in laboratory medicine. Clin Chim Acta 2014;432:135–47.CrossrefWeb of SciencePubMedGoogle Scholar

  • 6.

    Piva E, Plebani M. From “panic” to “critical” values: which path toward harmonization? Clin Chem Lab Med 2013;51:2069–71.Web of ScienceGoogle Scholar

  • 7.

    Campbell CA, Georgiou A, Westbrook JI, Horvath AR. What alert thresholds should be used to identify critical risk results: a systematic review of the evidence. Clin Chem Lab Med 2016;62:1–13.Google Scholar

  • 8.

    Lam Q, Ajzner E, Campbell CA, Young A. Critical risk results-and updated on international initiatives. EJIFCC 2016;27:66–76.Google Scholar

  • 9.

    Kost GJ, Hale KN. Global trends in critical values practices and their harmonization. Clin Chem Lab Med 2011;49:167–76.PubMedWeb of ScienceGoogle Scholar

  • 10.

    Kopcinovic LM, Trifunovic J, Pavosevic T, Nikolac N. Croatian survey on critical results reporting. Biochem Med 2015;25:193–202.CrossrefGoogle Scholar

  • 11.

    Don-Wauchope AC, Chetty VT. Laboratory defined critical value limits: how do hospital physicians perceive laboratory based critical values. Clin Biochem 2009;42:766–70.Web of SciencePubMedCrossrefGoogle Scholar

  • 12.

    Sikaris K. Performance criteria of the post-analytical phase. Clin Chem Lab Med 2015;53:949–58.PubMedWeb of ScienceGoogle Scholar

  • 13.

    Clinical and Laboratory Standard Institute (CLSI); Management of Critical- and Significant- Risk Results (GP47-Ed1). 2015. http://clsi.org.

  • 14.

    Monguet JM, Gutiérrez A, Ferruzca M, Alatriste Y, Martínez C, Córdoba C, et al. Vector consensus model. In: Quintela-Alves JE, Cruz-Cunha MM, editors. Organizational integration of enterprise systems and resources: advancements and applications. IGI Global, 2012:303–17.Google Scholar

  • 15.

    Phillips AC, Lewis LK, McEvoy MP, Galipeau J, Glasziou P, Hammick M, et al. A Delphi survey to determine how educational interventions for evidence-based practice should be reported: stage 2 of the development of a reporting guideline. BMC Med Educ 2014;14:159.CrossrefWeb of SciencePubMedGoogle Scholar

  • 16.

    Martí T, Monguet JM, Trejo A, Escarrabill J, Constante C. June 2014. Available from: http://upcommons.upc.edu/handle/2117/24737 (Collective Intelligence Conference 2014).

  • 17.

    Martí T, Monguet JM, Trejo A, Escarrabill J. June 2015. Available from: http://sites.lsa.umich.edu/wp-content/uploads/sites/176/2015/02/ (Collective Intelligence Conference 2015).

  • 18.

    Monguet JM, Trejo A, Martí T, Espallargues M, Serra-Sutton V, Escarrabill J. Assessment of chronic health care through an internet consensus tool. In: Dimitrios IF, editor. Handbook of research on trends in the diagnosis and treatment of chronic conditions. Hershey, Pennsylvania: IGI Global, 2015:424–43.Google Scholar

  • 19.

    López-Pelayo I, Fernández A, Romero De Castilla RJ, Zambrana JL. Clinical impact of laboratory critical values notification as a tool for patient safety [In Spanish]. Med Clin 2012;139:221–6.Google Scholar

  • 20.

    Doering TA, Plapp F, Crawford JM. Establishing an evidence base for critical laboratory value thresholds. Am J Clin Pathol 2014;142:617–28.PubMedCrossrefWeb of ScienceGoogle Scholar

  • 21.

    Saw S, Loh TP, Ang SB, Yip JW, Sethi SK. Meeting regulatory requirements by the use of cell phone text message notification with autoescalation and loop closure for reporting of critical laboratory results. Am J Clin Pathol 2011;136:30–4.Web of ScienceCrossrefGoogle Scholar

  • 22.

    Lippi G, Giaverina D, Montagnana M, Salvagno GL, Cappelleti GC, Plebani M, et al. National survey on critical values reporting in a cohort of italian laboratories. Clin Chem Lab med 2007;45:1411–3.Web of ScienceGoogle Scholar

  • 23.

    Llopis MA, Gomez R, Alvarez V, Martinez C, Cortes M, Barba N, et al. Critical values reporting: results of a Spanish laboratorios survey [In Spanish]. Rev Lab Clin 2010;3:177–82.Google Scholar

  • 24.

    Campbell CA, Horvath AR. Toward harmonisation of critical laboratory result management-review of the literature and survey of Australasian practices. Clin Biochem Rev 2012;334:149–60.Google Scholar

  • 25.

    Longtin Y, Sax H, Leape LL, Sheridan SE, Donaldson L, Pittet D. Patient participation: current knowledge and applicability to patient safety. Mayo Clin Proc 2010;85:53–62.CrossrefWeb of SciencePubMedGoogle Scholar

About the article

Received: 2017-05-02

Accepted: 2017-09-05

Published Online: 2017-10-23

Published in Print: 2018-02-23

Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

Research funding: IDIAP JORDI GOL Institut Catala de la Salut, 17 aid to research projects in primary health care.

Employment or leadership: None declared.

Honorarium: None declared.

Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.

Citation Information: Clinical Chemistry and Laboratory Medicine (CCLM), Volume 56, Issue 3, Pages 403–412, ISSN (Online) 1437-4331, ISSN (Print) 1434-6621, DOI: https://doi.org/10.1515/cclm-2017-0374.

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