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Laboratory Critical Limits

Richard H. Fine, MD
JAMA. 1990;264(3):335. doi:10.1001/jama.1990.03450030050019.
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To the Editor.—  Dr Kost's1 article and Dr Lundberg's2 editorial summarized some interesting data and made some valid suggestions for notifying clinicians about critical, panic, and/or vital laboratory results. The thrust of their remarks primarily addresses hospitalized patients.In ambulatory care, a situation often arises in which a critical result is obtained on the evening run by the laboratory, when the clinic is closed and the physician not in the house. In our outpatient clinics at San Francisco General Hospital, we have identified a group of tests that we call PANIC values, which cannot wait until the next working day for clinical action. We use the following protocol for these critical results, which might be of use to fellow clinicians:The following "supercritical" abnormal results must be reported immediately to the ordering provider or to the GMC [general medical clinic] on call attending physician (see GMC On Call


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