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

Maria Isabel Llovet 1 , Carmen Biosca 2 , Alicia Martínez-Iribarren 2 , Aurora Blanco 3 , Glòria Busquets 4 , María José Castro 3 , Maria Antonia Llopis 2 , Mercè Montesinos 4 , Joana Minchinela 2 , Carme Perich 5 , Judith Prieto 6 , Rosa Ruiz 7 , Núria Serrat 8 , Margarita Simón 9 , Alex Trejo 10 , Josep Maria Monguet 11 , Carlos López-Pablo 12  and Mercè Ibarz 6
  • 1 Medical Laboratory ICS Terres de l’Ebre, 14, 43500 Tortosa, Spain
  • 2 Medical Laboratory ICS Barcelonés Nord i Vallès Oriental, Badalona, Spain
  • 3 Medical Laboratory Universitary Hospital Bellvitge, Barcelona, Spain
  • 4 Medical Laboratory ICS Girona, Girona, Spain
  • 5 Medical Laboratory Universitary Hospital Vall d’Hebron, Barcelona, Catalunya, Spain
  • 6 Medical Laboratory ICS Lleida, Lleida, Catalunya, Spain
  • 7 Medical Laboratory ICS L’Hospitalet, Barcelona, Spain
  • 8 Medical Laboratory ICS Camp de Tarragona, Tarragona, Spain
  • 9 Medical Laboratory Consorci Intercomarcal Anoia, Penedès i Garraf (CLI), Vilafranca del Penedes, Spain
  • 10 Onsanity Solutions S.L., Barcelona, Spain
  • 11 UPC Barcelona Tech., Barcelona, Catalunya, Spain
  • 12 Molecular Biology and Research Section Hospital Verge de la Cinta, Tortosa, Catalunya, Spain
Maria Isabel Llovet
  • Corresponding author
  • Medical Laboratory ICS Terres de l’Ebre, Hospital Verge de la Cinta, C/Esplanetes, 14, 43500 Tortosa, Spain
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, Carmen Biosca, Alicia Martínez-Iribarren, Aurora Blanco, Glòria Busquets, María José Castro, Maria Antonia Llopis, Mercè Montesinos, Joana Minchinela, Carme Perich
  • Medical Laboratory Universitary Hospital Vall d’Hebron, Barcelona, Catalunya, Spain
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, Judith Prieto, Rosa Ruiz, Núria Serrat, Margarita Simón
  • Medical Laboratory Consorci Intercomarcal Anoia, Penedès i Garraf (CLI), Vilafranca del Penedes, Spain
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, Alex Trejo, Josep Maria Monguet, Carlos López-Pablo
  • Molecular Biology and Research Section Hospital Verge de la Cinta, Tortosa, Catalunya, Spain
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and Mercè Ibarz



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.

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Clinical Chemistry and Laboratory Medicine ( CCLM) publishes articles on novel teaching and training methods applicable to laboratory medicine. CCLM welcomes contributions on the progress in fundamental and applied research and cutting-edge clinical laboratory medicine. It is one of the leading journals in the field, with an impact factor of over three. CCLM is the official journal of nine national clinical societies and associated with EFLM.