As a Houston, Texas medical malpractice attorney, I have handled a lot of cases where critical lab values were not handled properly, resulting in serious injury or death of patients.
A critical lab value is potentially life-threatening and needs immediate attention by a clinical physician. Yet, all too often the laboratory results are reported back in a routine fashion, with no sense of urgency. In recent years, researchers have devoted a significant amount of attention to this problem, in the hope of improving patient safety and outcomes.
Ensuring that critical lab results get noticed
Most hospitals, labs, doctors, and nurses are extremely busy caring for lots of patients with a variety of healthcare needs. Despite this fact, critical lab results need to go to the front of the line.
The standard of care requires laboratory staff to notify the ordering physician immediately when there is a critical lab value. Sometimes this is accomplished by speaking with an intermediary, such as a registered nurse. Researchers have found that this step of communication itself has the potential for errors.
This is why experts recommend, and the standard of care has evolved to require, verification that the doctor or nurse actually heard the correct critical information that was being communicated.
Some hospitals have wisely implemented policies and procedures requiring laboratory personnel to have the ordering physician or registered nurse read back the critical lab result that was shared. One hospital went so far as to specifically require the laboratory staff reporting the critical lab value to use these exact words, “I have a critical result to report. You will need to write down and read the information back to me to verify accuracy.” What a great idea!
Other problem areas
As with so many other things in our lives, a lab computer determines whether blood work or other testing has an abnormal value.
Of course, someone from the hospital or laboratory facility has to program the computer with ranges for low, critical low, normal, high, and critical high. When a print out of lab work is done, an abnormal value will be flagged one way, and a critical value flagged another way.
Practically speaking, almost all laboratory personnel rely on the computer flags, rather than reviewing the values themselves.
A December 2016 article in the Milwaukee Journal Sentinel highlighted how a tiny, minuscule difference in a lab value versus the pre-programmed computer critical level can make a huge difference in a patient’s outcome.
The story profiled a baby named Mel Russell. At birth, a doctor or nurse pricked the heel of his foot to get a blood sample to be sent to a public health lab. All 50 states require this testing, to allow screening for serious, but treatable, genetic conditions. Experts say that around 12,000 lives are saved each year because of this newborn screening program.
Baby Mel was normal and healthy at birth, as is often the case. The results of his initial heel prick test, though came back to his pediatrician on a blue piece of paper stating “POSSIBLE ABNORMAL.”
The report requested that the pediatrician order retesting, which was done. About a week later, the test results from the retest came back stating on a white piece of paper stating “NORMAL.”
If the retest had come back abnormal, the baby would have been referred to a specialist for treatment of a rare metabolic disorder.
As a result of that normal retest, though the pediatrician did not send him to a specialist or implement any additional treatment.
At the age of 18 months, the little boy had a stroke brought on by a metabolic condition that overwhelmed his body and brain. He also had propionic academia, which prevented him from metabolizing certain fats and proteins normally. Both of these conditions would have been treated and cured if the retest had come back as abnormal.
A Texas laboratory expert involved in the litigation of baby Mel’s case said that each laboratory develops its own policies and procedures, which means that a value that is critical and one lab may not be critical in another lab.
Babies with borderline test results are the most at risk. Mel’s rested lab value was 0.1998380, which is barely not 0.20, which was that lab’s threshold for a critical value. That tiny distinction made all the difference in his life.
This type of risk is not only an issue for babies. The critical values assigned by laboratories in different hospitals and facilities vary, and once again can impact patients with borderline test results.
What you can do
I think it is a big gamble to leave the decision-making over lab work to somewhat arbitrary computer programming done at a particular hospital or facility. That is why that I recommend that patients always request a copy of their lab test results for themselves. The same is true for radiology reports and other types of tests.
Lab reports are actually fairly easy to read. For each test, the patient’s value will be printed and there will be an indicator that explains whether it is a low, high, or critical value. In addition the normal ranges are also provided for each value. If you review a lab result and find that you barely missed a critical cut-off level, this is something that you should bring to the attention of your doctor.
Ask questions like what does that lab value mean, what are the risks of having a critical, or near-critical lab value, should you be retested, and what symptoms should you look out for. These questions will politely force your physician to look at the lab reports more thoroughly, rather than relying on criteria that someone else set for test results.
We are here to help
If you or someone you care for has been seriously injured as a result of the lab test or result that went on communicated, unnoticed, or untreated, call Painter Law Firm, at 281-580-8800, for a free consultation about your potential case.
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Robert Painter is an attorney at Painter Law Firm PLLC, where he represents plaintiffs in medical negligence lawsuits. He focuses his practice on medical malpractice cases and sues hospitals, labs, doctors, and pharmacies on behalf of his clients.
