Background
Stating the problem
Significance of research
Research objectives
Methods
Study design
Study settings and study period
Research tool
Data collection and sampling
Operational definition
Policy and guidelines | Outlines of what to do in any situation involving a laboratory |
---|---|
Knowledge | Information about specific practices |
Limits | Reference ranges for critical values (high and low) |
Doctor | Laboratory physician |
Technician | Laboratory staff (non-physician) |
Phlebotomist | Staff trained in withdrawing blood from patients |
Critical values | Abnormal limits in laboratory tests ranges |
Data analysis and processing
Results
Hospital statistics and socio-demographic characteristics
Hospital A | Hospital B | Hospital C | Hospital D | Hospital E | p | Total | |||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
N | % | N | % | N | % | N | % | N | % | N | % | ||
Hospital | |||||||||||||
Bed number | 218 | (7.3) | 414 | (13.8) | 868 | (29.0) | 725 | (24.2) | 765 | (25.6) | 2990 | ||
Bed occupancy rate | 54% | 70% | 59% | 66% | 69% | 64.4% | |||||||
Laboratories | |||||||||||||
Unit number | 14 | (36.8) | 6 | (15.8) | 5 | (13.2) | 8 | (21.1) | 5 | (13.2) | 38 | ||
Staff number | |||||||||||||
Doctors | 33 | (19.5) | 26 | (12.6) | 26 | (8.8) | 60 | (5.9) | 26 | (11.4) | 171 | (8.9) | |
Technicians | 121 | (71.6) | 169 | (81.6) | 242 | (82.0) | 941 | (93.0) | 189 | (82.5) | 1662 | (86.9) | |
Phlebotomists | 15 | (8.9) | 12 | (5.8) | 27 | (9.2) | 11 | (1.1) | 14 | (6.1) | 79 | (4.1) | |
Test number (in millions) | 1.684 | (6.6) | 7.441 | (29.0) | 4.518 | (17.6) | 6.343 | (24.7) | 5.698 | (22.2) | 25.684 | ||
Participants | |||||||||||||
Response rate | 42.2% | 46.7% | 58.2% | 10.0% | 68.8% | 30.6% | |||||||
Gender | < .001 | ||||||||||||
Male | 23 | (35.4) | 23 | (25.3) | 69 | (44.5) | 28 | (28.0) | 73 | (49.3) | 216 | (38.6) | |
Female | 42 | (64.6) | 68 | (74.7) | 86 | (55.5) | 72 | (72.0) | 75 | (50.7) | 343 | (61.4) | |
Age | .166 | ||||||||||||
Below 30 years | 27 | (41.5) | 31 | (34.1) | 34 | (21.8) | 31 | (31.6) | 53 | (35.8) | 176 | (31.5) | |
30–45 years | 31 | (47.7) | 41 | (45.1) | 90 | (57.7) | 53 | (54.1) | 71 | (48.0) | 286 | (51.3) | |
46–55 years | 5 | (7.7) | 9 | (9.9) | 18 | (11.5) | 7 | (7.1) | 16 | (10.8) | 55 | (9.9) | |
Over 55 years | 2 | (3.1) | 10 | (11.0) | 14 | (9.0) | 7 | (7.1) | 8 | (5.4) | 41 | (7.3) | |
Nationality | < .001 | ||||||||||||
Kuwaiti | 36 | (55.4) | 47 | (51.6) | 46 | (29.7) | 52 | (52.0) | 17 | (11.6) | 198 | (35.5) | |
Non-Kuwaiti | 29 | (44.6) | 44 | (48.4) | 109 | (70.3) | 48 | (48.0) | 130 | (88.4) | 360 | (64.5) | |
Profession | .002 | ||||||||||||
Doctor | 10 | (15.4) | 14 | (15.6) | 5 | (3.2) | 18 | (18.0) | 20 | (13.6) | .378 | 67 | (12.0) |
Assistant register | − | − | 1 | (7.1) | − | − | 5 | (27.8) | 1 | (5.0) | 7 | (10.4) | |
Register | 3 | (30.0) | 3 | (21.4) | 2 | (40.0) | 5 | (27.8) | 11 | (55.0) | 24 | (35.8) | |
Senior register | 3 | (30.0) | 3 | (21.4) | 3 | (60.0) | 3 | (16.7) | 3 | (15.0) | 15 | (22.4) | |
Specialist | 1 | (10.0) | 3 | (21.4) | − | − | 3 | (16.7) | 2 | (10.0) | 9 | (13.4) | |
Senior specialist | 1 | (10.0) | 1 | (7.1) | − | − | 1 | (5.6) | 2 | (10.0) | 5 | (7.5) | |
Consultant | 2 | (20.0) | 3 | (21.4) | − | − | 1 | (5.6) | 1 | (5.0) | 7 | (10.4) | |
Technician | 55 | (84.6) | 76 | (84.4) | 151 | (96.8) | 82 | (82.0) | 127 | (86.4) | < .001 | 491 | (88.0) |
Assistant practitioner | 2 | (3.6) | 5 | (6.6) | 7 | (4.7) | 6 | (7.4) | 8 | (6.3) | 28 | (5.7) | |
Practitioner | 13 | (23.6) | 6 | (7.9) | 5 | (3.3) | 9 | (11.1) | 2 | (1.6) | 35 | (7.2) | |
Senior practitioner | 5 | (9.1) | − | − | 8 | (5.3) | 4 | (4.9) | 4 | (3.1) | 21 | (4.3) | |
Assistant technician | − | − | 3 | (3.9) | 10 | (6.7) | 1 | (1.2) | 8 | (6.3) | 22 | (4.5) | |
Technician | 28 | (50.9) | 37 | (48.7) | 71 | (47.3) | 42 | (51.9) | 85 | (66.9) | 263 | (53.8) | |
Senior technician | 4 | (7.3) | 7 | (9.2) | 21 | (14.0) | 3 | (3.7) | 4 | (3.1) | 39 | (8.0) | |
Specialist | 3 | (5.5) | 9 | (11.8) | 10 | (6.7) | 6 | (7.4) | 7 | (5.5) | 35 | (7.2) | |
Senior specialist | − | − | 9 | (11.8) | 18 | (12.0) | 10 | (12.3) | 9 | (7.1) | 46 | (9.4) | |
Position | .010 | ||||||||||||
Head of department | 3 | (4.8) | 1 | (1.1) | 1 | (0.7) | − | − | − | − | 5 | (0.9) | |
Head of unit | 2 | (3.2) | 3 | (3.4) | 2 | (1.3) | − | − | 4 | (2.8) | 11 | (2.0) | |
Laboratory doctor | 6 | (9.5) | 10 | (11.2) | 4 | (2.7) | 15 | (15.6) | 16 | (11.1) | 51 | (9.4) | |
Head of laboratory technicians | 2 | (3.2) | 4 | (4.5) | 6 | (4.0) | 3 | (3.1) | 2 | (1.4) | 17 | (3.1) | |
Technician | 50 | (79.4) | 71 | (79.8) | 137 | (91.3) | 78 | (81.3) | 122 | (84.7) | 458 | (84.5) | |
Unit | < .001 | ||||||||||||
Microbiology | − | − | 19 | (20.9) | 35 | (24.1) | 20 | (20.0) | 37 | (25.0) | 111 | (20.2) | |
Hematology | 1 | (1.5) | 31 | (34.1) | 50 | (34.5) | 42 | (42.0) | 56 | (37.8) | 180 | (32.8) | |
Biochemistry | 11 | (16.9) | 27 | (29.7) | 44 | (30.3) | 1 | (1.0) | 43 | (29.1) | 126 | (23.0) | |
Histopathology | 13 | (20.0) | 6 | (6.6) | 10 | (6.9) | 17 | (17.0) | 5 | (3.4) | 51 | (9.3) | |
Immunology | 16 | (24.6) | − | − | − | − | 11 | (11.0) | − | − | 27 | (4.9) | |
Virology | 15 | (23.1) | − | − | 6 | (4.1) | 9 | (9.0) | 7 | (4.7) | 37 | (6.7) | |
Molecular genetics | 9 | (13.8) | − | − | − | − | − | − | − | 9 | (1.6) | ||
Reception | − | − | 8 | (8.8) | − | − | − | − | − | 8 | (1.5) |
Critical value policies and procedures
Hospital A | Hospital B | Hospital C | Hospital D | Hospital E |
p
| Total | |||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
n
| (%) |
n
| (%) |
n
| (%) |
n
| (%) |
n
| (%) |
n
| (%) | ||
Critical values reporting is | .026 | ||||||||||||
Minor policy | 2 | (3.3) | 1 | (1.1) | 7 | (4.6) | 7 | (7.2) | 5 | (3.4) | 22 | (4.1) | |
Somewhat important | 8 | (13.3) | 9 | (10.2) | 16 | (10.5) | 3 | (3.1) | 5 | (3.4) | 41 | (7.6) | |
An essential procedure | 50 | (83.3) | 78 | (88.6) | 129 | (84.9) | 87 | (89.7) | 136 | (93.2) | 480 | (88.4) | |
Presence of written procedures for critical value reporting | 53 | (82.8) | 80 | (89.9) | 138 | (90.2) | 83 | (83) | 142 | (95.9) | .011 | 496 | (89.5) |
Presence of a comprehensive list of critical values | 41 | (69.5) | 76 | (84.4) | 137 | (89.0) | 74 | (79.6) | 142 | (96.6) | < .001 | 470 | (86.6) |
Number of tests in the list | |||||||||||||
Range | 0–32 | 4–50 | 1–30 | 2–90 | 3–25 | 0–90 | |||||||
Mean ± SD | 13.92 ± 10.26 | 15.02 ± 7.06 | 12.28 ± 7.34 | 12.02 ± 16.50 | 11.76 ± 7.20 | .237 | 12.67 ± 9.36 | ||||||
Median | 15.5 | 16 | 10 | 5 | 9 | 10 | |||||||
Critical value list was developed based on† | |||||||||||||
Published literature | 17 | (26.2) | 26 | (28.6) | 26 | (16.7) | 21 | (21.0) | 26 | (17.6) | .134 | 116 | (20.7) |
Opinion of clinicians | 10 | (15.4) | 32 | (35.2) | 14 | (9.0) | 30 | (30.0) | 47 | (31.0) | < .001 | 133 | (23.2) |
Medical societies' recommendations | 9 | (13.8) | 37 | (40.7) | 35 | (22.4) | 30 | (30.0) | 69 | (46.0) | < .001 | 180 | (32.1) |
Manufacturer's recommendations | 3 | (4.6) | 9 | (9.9) | 14 | (9.0) | 16 | (16.0) | 10 | (6.8) | .084 | 52 | (9.3) |
Review of laboratory practice | 20 | (30.8) | 38 | (41.8) | 54 | (34.6) | 21 | (21.0) | 32 | (21.6) | .002 | 165 | (29.5) |
Informal laboratory peer review | 6 | (9.2) | 10 | (11.0) | 3 | (1.9) | 4 | (4.0) | 2 | (1.4) | .001 | 25 | (4.5) |
Others | 7 | (10.8) | 2 | (2.2) | 10 | (6.4) | 1 | (1.0) | 11 | (7.4) | .032 | 31 | (5.5) |
No answers | 16 | (24.6) | 13 | (14.3) | 21 | (13.5) | 18 | (18.0) | 1 | (0.7) | < .001 | 69 | (12.3) |
Laboratory personnel trained on reporting critical values | 52 | (83.9) | 85 | (94.4) | 144 | (93.5) | 87 | (88.8) | 140 | (95.2) | .046 | 508 | (92.2) |
Critical values procedures are regularly updated | 49 | (79.0) | 78 | (89.7) | 118 | (77.6) | 79 | (82.3) | 141 | (95.9) | < .001 | 465 | (85.5) |
Unique ranges for distinct population by age | 14 | (22.2) | 66 | (73.3) | 111 | (72.5) | 52 | (54.2) | 105 | (72.4) | < .001 | 348 | (63.6) |
Unique ranges for distinct population by diagnosis | 23 | (35.4) | 26 | (32.5) | 59 | (40.4) | 44 | (44.9) | 68 | (47.9) | .001 | 220 | (41.4) |
Policy for assessing timeliness of reporting | 59 | (90.8) | 70 | (79.5) | 113 | (74.3) | 87 | (88.8) | 135 | (91.8) | < .001 | 464 | (84.4) |
Policy on how to manage the repetition of critical values | 51 | (79.7) | 75 | (90.4) | 136 | (87.7) | 82 | (84.5) | 135 | (92.5) | .002 | 479 | (87.9) |
Laboratory policy requires read back | 20 | (35.7) | 81 | (92.0) | 123 | (80.4) | 72 | (75.0) | 127 | (88.2) | < .001 | 423 | (78.8) |
Participants’ practices and reporting
Hospital A | Hospital B | Hospital C | Hospital D | Hospital E | p | Total | |||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
n | (%) | n | (%) | n | (%) | n | (%) | n | (%) | n | (%) | ||
Communicate critical values immediately upon their identification | 51 | (83.6) | 80 | (92.0) | 144 | (93.5) | 86 | (86.9) | 140 | (95.9) | .036 | 501 | (91.6) |
Person responsible for making the call† | |||||||||||||
Senior staff | 15 | (23.1) | 54 | (59.3) | 73 | (46.8) | 43 | (43.0) | 79 | (53.4) | < .001 | 264 | (47.1) |
Laboratory technician | 16 | (24.6) | 70 | (76.9) | 97 | (62.2) | 67 | (67.0) | 102 | (68.9) | < .001 | 352 | (62.9) |
Others | 41 | (63.1) | 19 | (20.9) | 22 | (14.1) | 24 | (24.0) | 32 | (21.6) | < .001 | 138 | (24.6) |
No answers | 5 | (7.7) | 3 | (3.3) | 3 | (1.9) | 4 | (4.0) | 1 | (0.7) | .053 | 16 | (2.9) |
Person who receives the call† | |||||||||||||
Physicians ordering the test | 42 | (64.6) | 57 | (62.6) | 92 | (59.0) | 52 | (52.0) | 114 | (77.0) | .001 | 357 | (63.7) |
Nurses | 25 | (38.5) | 72 | (79.1) | 73 | (46.8) | 59 | (59.0) | 110 | (74.3) | < .001 | 339 | (60.5) |
Any physician on call | 28 | (43.1) | 42 | (46.2) | 40 | (25.6) | 39 | (39.0) | 82 | (55.4) | < .001 | 231 | (41.3) |
Any people working on the ward | 7 | (10.8) | 11 | (12.1) | 14 | (9.0) | 15 | (15.0) | 9 | (6.1) | .201 | 56 | (10.0) |
Others | 4 | (6.2) | 6 | (6.6) | 7 | (4.5) | 2 | (2.0) | 3 | (2.0) | .252 | 22 | (3.9) |
No answers | 5 | (7.7) | 1 | (1.1) | 3 | (1.9) | 5 | (5.0) | 1 | (0.7) | .021 | 15 | (2.7) |
Critical values are reported to the caregiver mainly by† | |||||||||||||
Sending test report to ward | 28 | (43.1) | 36 | (39.6) | 36 | (23.1) | 33 | (33.0) | 22 | (14.9) | < .001 | 155 | (27.7) |
Telephone | 40 | (61.5) | 57 | (62.6) | 95 | (60.9) | 55 | (55.0) | 121 | (81.8) | < .001 | 368 | (65.7) |
Computer | 11 | (16.9) | 34 | (37.4) | 49 | (31.4) | 54 | (54.0) | 57 | (38.5) | < .001 | 205 | (36.6) |
Direct contact with requesting physician | 34 | (52.3) | 20 | (22.0) | 74 | (47.4) | 33 | (33.0) | 34 | (23.0) | < .001 | 195 | (34.8) |
Fax | 0 | (0.0) | 0 | (0.0) | 1 | (0.6) | 1 | (1.0) | 0 | (0.0) | .855 | 2 | (0.4) |
All tools | 10 | (15.4) | 28 | (30.8) | 15 | (9.6) | 24 | (24.0) | 14 | (9.5) | < .001 | 91 | (16.3) |
No answers | 8 | (12.3) | 1 | (1.1) | 2 | (1.3) | 1 | (1.0) | 1 | (0.7) | < .001 | 13 | (2.3) |
Wireless technologies used to report critical values | 18 | (29.5) | 31 | (35.2) | 52 | (34.2) | 42 | (43.8) | 36 | (25.0) | .032 | 179 | (33.1) |
Re-testing for critical values verification | 49 | (80.3) | 81 | (92.0) | 152 | (97.4) | 79 | (79.8) | 141 | (96.6) | < .001 | 502 | (91.3) |
In sample re-testing, the person responsible for drawing the sample contacted to verify the validity of drawing the sample | 25 | (43.1) | 51 | (61.4) | 102 | (66.7) | 55 | (59.1) | 77 | (53.5) | < .001 | 310 | (58.4) |
In case of handling repeat critical values from the same patient, the usual practice is to: | < .001 | ||||||||||||
Report initial critical value and all subsequent critical values, regardless of previous results | 25 | (49.0) | 36 | (42.4) | 59 | (41.0) | 36 | (40.0) | 68 | (51.5) | 224 | (44.6) | |
Report worsening values, values that were "grossly different" from previous values, and values that moved in and out | 5 | (9.8) | 29 | (34.1) | 23 | (16.0) | 27 | (30.0) | 37 | (28.0) | 121 | (24.1) | |
Report repeated critical values once per interval of time | 21 | (41.2) | 20 | (23.5) | 62 | (43.1) | 27 | (30.0) | 27 | (20.5) | 157 | (31.3) | |
Reported critical laboratory values are documented:† | |||||||||||||
In the computer system | 15 | (23.1) | 31 | (34.1) | 56 | (35.9) | 38 | (38.0) | 45 | (30.4) | .276 | 185 | (33.0) |
Written on the result form | 8 | (12.3) | 19 | (20.9) | 24 | (15.4) | 12 | (12.0) | 21 | (14.2) | .457 | 84 | (15.0) |
Documented in the laboratory register | 14 | (21.5) | 23 | (25.3) | 45 | (28.8) | 19 | (19.0) | 30 | (20.3) | .311 | 131 | (23.4) |
All of the above | 39 | (60.0) | 43 | (47.3) | 73 | (46.8) | 48 | (48.0) | 84 | (56.8) | .197 | 287 | (51.2) |
It is not documented | 0 | (0.0) | 2 | (2.2) | 0 | (0.0) | 2 | (2.0) | 1 | (0.7) | .205 | 5 | (0.9) |
No answers | 6 | (9.2) | 1 | (1.1) | 4 | (2.5) | 0 | (0.0) | 3 | (2.0) | .010 | 14 | (2.5) |
In case of documenting verbal communication on a log, the following is included:† | |||||||||||||
Identification of patient | 13 | (20.0) | 28 | (30.8) | 65 | (41.7) | 37 | (37.0) | 33 | (22.3) | .001 | 176 | (31.4) |
Identification of sender | 3 | (4.6) | 7 | (7.7) | 14 | (9.0) | 11 | (11.0) | 9 | (6.1) | .521 | 44 | (7.9) |
Identification of recipient (person receiving the report) | 6 | (9.2) | 19 | (20.9) | 31 | (19.9) | 23 | (23.0) | 22 | (14.9) | .139 | 101 | (18.0) |
Critical test result reported | 10 | (15.4) | 20 | (22.0) | 53 | (34.0) | 19 | (19.0) | 21 | (14.2) | < .001 | 123 | (22.0) |
Date and time of reporting | 11 | (16.9) | 22 | (24.2) | 51 | (32.7) | 25 | (25.0) | 31 | (20.9) | .074 | 140 | (25.0) |
All information | 31 | (47.7) | 47 | (51.6) | 55 | (35.3) | 47 | (47.0) | 99 | (66.9) | < .001 | 279 | (49.8) |
No answers | 16 | (24.6) | 6 | (6.6) | 25 | (16.0) | 7 | (7.0) | 5 | (3.4) | < .001 | 59 | (7.9) |
The time from result availability to the responsible caregiver notification is measured | 39 | (63.9) | 60 | (69.0) | 112 | (75.7) | 65 | (69.1) | 111 | (76.0) | .025 | 387 | (72.2) |
Reasons for delay in reporting critical values:† | |||||||||||||
Getting someone to accept the results | 20 | (30.8) | 49 | (53.8) | 48 | (30.8) | 21 | (21.0) | 30 | (20.3) | < .001 | 168 | (30.0) |
Reporting critical values to the physician responsible for the patient | 15 | (23.1) | 46 | (50.5) | 52 | (33.3) | 16 | (16.0) | 23 | (15.5) | < .001 | 152 | (27.1) |
Knowing the name of the assigned physician | 7 | (10.8) | 29 | (31.9) | 19 | (12.2) | 12 | (12.0) | 30 | (20.3) | .001 | 97 | (17.3) |
Provider contact information is not available | 24 | (36.9) | 54 | (59.3) | 48 | (30.8) | 39 | (39.0) | 73 | (49.3) | < .001 | 238 | (42.5) |
The person receiving the result is unwilling to read it back to ensure that it is correct | 5 | (7.7) | 14 | (15.4) | 15 | (9.6) | 10 | (10.0) | 24 | (16.2) | .294 | 68 | (12.1) |
List of critical values is too long | 0 | (0.0) | 5 | (5.5) | 6 | (3.8) | 2 | (2.0) | 4 | (2.7) | .450 | 17 | (3.0) |
Reporting critical results disrupts the workflow | 0 | (0.0) | 19 | (20.9) | 8 | (5.1) | 6 | (6.0) | 12 | (8.1) | < .001 | 45 | (8.0) |
Discharged patients at the time of reporting the result | 11 | (16.9) | 41 | (45.1) | 49 | (31.4) | 35 | (35.0) | 51 | (34.5) | .046 | 187 | (33.4) |
There are no difficulties | 15 | (23.1) | 4 | (4.4) | 36 | (23.1) | 33 | (33.0) | 28 | (18.9) | < .001 | 116 | (20.7) |
No answers | 17 | (26.2) | 7 | (7.7) | 14 | (9.0) | 8 | (8.0) | 12 | (8.1) | .001 | 58 | (10.4) |
There is a delay in reporting critical laboratory values | 4 | (7.0) | 22 | (25.9) | 31 | (20.8) | 12 | (12.6) | 29 | (21.0) | .112 | 98 | (18.7) |
Satisfied with the way a staff would report critical laboratory values | 42 | (73.7) | 75 | (86.2) | 132 | (86.8) | 81 | (84.4) | 129 | (93.5) | .002 | 459 | (86.6) |
The average time from result availability to the responsible caregiver notification in each of the following shifts | |||||||||||||
Morning shift | |||||||||||||
Range | 0 – 600 | 10 – 4320 | 0 – 120 | 5 – 2880 | 0 – 1440 | 0 – 4320 | |||||||
Mean ± SD | 150.21 ± 760.53 | 153.13 ± 760.53 | 26.89 ± 28.66 | 303.54 ± 795.09 | 78.08 ± 250.62 | .048 | 104.55 ± 408.16 | ||||||
Median | 120 | 10 | 30 | 60 | 30 | 30 | |||||||
Evening shift | |||||||||||||
Range | 0 – 2880 | 10 – 60 | 0 – 120 | 5 – 120 | 0 – 1440 | 0 – 2880 | |||||||
Mean ± SD | 447.5 ± 765.82 | 19 ± 15.94 | 19.58 ± 27.08 | 61.25 ± 46.11 | 77.28 ± 250.43 | < .001 | 94.44 ± 317.18 | ||||||
Median | 120 | 10 | 10 | 30 | 30 | 30 | |||||||
Night shift | |||||||||||||
Range | 0 – 120 | 10 – 60 | 0 – 120 | 5 – 120 | 0 – 1440 | 0 – 1440 | |||||||
Mean ± SD | 83.21 ± 51.8 | 18.33 ± 14.99 | 21.94 ± 29.8 | 61.25 ± 46.11 | 77.28 ± 250.43 | .389 | 60.36 ± 191.45 | ||||||
Median | 120 | 10 | 5 | 30 | 30 | 30 |
Commonly performed tests critical values
Hospital A | Hospital B | Hospital C | Hospital D | Hospital E | p | Total | ||||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
V | N | n | % | V | N | n | % | V | N | n | % | V | N | n | % | V | N | n | % | N | n | % | ||
Potassium | ||||||||||||||||||||||||
Lower Limit | 2.5 | 1 | 0 | 0.0 | 2.5 | 27 | 25 | 92.6 | 2.8 | 15 | 1 | 6.7 | 2.5 | 4 | 0 | 0.0 | 2.8 | 37 | 34 | 91.9 | < .001 | 84 | 60 | 71.0 |
Upper Limit | 6.6 | 1 | 0 | 0.0 | 6.5 | 27 | 25 | 92.6 | 6.2 | 14 | 3 | 21.4 | 6.5 | 4 | 0 | 0.0 | 6.5 | 38 | 36 | 94.7 | < .001 | 84 | 64 | 76.2 |
Unit | mmol/L | 2 | 2 | 100 | mmol/L | 24 | 24 | 100 | mmol/L | 31 | 30 | 96.8 | mmol/L | 2 | 2 | 100 | mmol/L | 45 | 45 | 100 | .566 | 104 | 103 | 99.0 |
Sodium | ||||||||||||||||||||||||
Lower Limit | 120 | 1 | 1 | 100 | 120 | 27 | 25 | 92.6 | 120 | 14 | 11 | 78.6 | 120 | 4 | 0 | 0.0 | 120 | 38 | 34 | 89.5 | .001 | 84 | 71 | 84.5 |
Upper Limit | 160 | 1 | 1 | 100 | 160 | 27 | 25 | 92.6 | 160 | 14 | 11 | 78.6 | 160 | 4 | 0 | 0.0 | 160 | 38 | 36 | 94.7 | < .001 | 84 | 73 | 86.9 |
Unit | mmol/L | 2 | 2 | 100 | mmol/L | 23 | 23 | 100 | mmol/L | 31 | 23 | 74.2 | mmol/L | 2 | 2 | 100 | mmol/L | 45 | 45 | 100 | .001 | 103 | 95 | 92.2 |
Magnesium | ||||||||||||||||||||||||
Lower Limit | 0.4 | 1 | 0 | 0.0 | 0.4 | 25 | 24 | 96.0 | 0.5 | 12 | 11 | 91.7 | 0.4 | 2 | 0 | 0.0 | 0.5 | 36 | 36 | 100 | < .001 | 76 | 71 | 93.4 |
Upper Limit | None | 0 | 0 | 0.0 | 3.7 | 25 | 24 | 96.0 | 1.9 | 12 | 1 | 8.3 | None | 0 | 0 | 0.0 | 1.9 | 37 | 34 | 91.9 | < .001 | 74 | 59 | 79.7 |
Unit | mmol/L | 2 | 2 | 100 | mmol/L | 23 | 23 | 100 | mmol/L | 30 | 19 | 63.3 | mmol/L | 2 | 2 | 100 | mmol/L | 43 | 43 | 100 | < .001 | 100 | 89 | 89.0 |
Calcium | ||||||||||||||||||||||||
Lower Limit | 1.65 | 1 | 0 | 0.0 | 1.5 | 27 | 25 | 92.6 | 1.5 | 14 | 3 | 21.4 | 1.8 | 3 | 0 | 0.0 | 1.5 | 37 | 36 | 97.3 | < .001 | 82 | 64 | 78.0 |
Upper Limit | 3.25 | 1 | 1 | 100 | 3.5 | 27 | 24 | 88.9 | 3.2 | 15 | 1 | 6.7 | 3.5 | 2 | 0 | 0.0 | 3.2 | 37 | 36 | 97.3 | < .001 | 82 | 62 | 75.6 |
Unit | mmol/L | 1 | 1 | 100 | mmol/L | 24 | 24 | 100 | mmol/L | 29 | 18 | 62.1 | mmol/L | 2 | 2 | 100 | mmol/L | 43 | 43 | 100 | < .001 | 99 | 88 | 88.9 |
Phosphorous | ||||||||||||||||||||||||
Lower Limit | 0.32 | 1 | 1 | 100 | 0.36 | 23 | 22 | 95.7 | None | 0 | 0 | 0.0 | 0.3 | 0 | 0 | 0.0 | None | 0 | 0 | 0.0 | > .999 | 24 | 23 | 95.8 |
Upper Limit | None | 0 | 0 | 0.0 | None | 0 | 0 | 0.0 | None | 0 | 0 | 0.0 | 2.9 | 0 | 0 | 0.0 | None | 0 | 0 | 0.0 | 0 | 0 | 0.0 | |
Unit | mmol/L | 2 | 2 | 100 | mmol/L | 20 | 20 | 100 | None | 0 | 0 | 0.0 | mmol/L | 0 | 0 | 0.0 | None | 0 | 0 | 0.0 | 22 | 22 | 100 | |
Bilirubin | ||||||||||||||||||||||||
Upper Limit | None | 0 | 0 | 0.0 | 340 | 25 | 23 | 92.0 | 239 | 14 | 2 | 14.3 | 25 | 2 | 1 | 50.0 | 299 | 17 | 1 | 5.9 | < .001 | 58 | 27 | 46.6 |
Unit | None | 0 | 0 | 0.0 | µmol/L | 23 | 0 | 0.0 | mmol/L | 23 | 6 | 26.1 | µmol/L | 1 | 0 | 0.0 | mmol/L | 25 | 22 | 88.0 | < .001 | 72 | 28 | 38.9 |
BUN | ||||||||||||||||||||||||
Upper Limit | None | 0 | 0 | 0.0 | R | 0 | 0 | 0.0 | None | 0 | 0 | 0.0 | None | 0 | 0 | 0.0 | 28.56 | 28 | 19 | 67.9 | 28 | 19 | 67.9 | |
Unit | None | 0 | 0 | 0.0 | R | 0 | 0 | 0.0 | None | 0 | 0 | 0.0 | None | 0 | 0 | 100 | mmol/L | 28 | 26 | 92.9 | 28 | 26 | 92.9 | |
Creatinine | ||||||||||||||||||||||||
Upper Limit | 650 | 1 | 0 | 0.0 | None | 0 | 0 | 0.0 | None | 0 | 0 | 0.0 | 350 | 3 | 0 | 0.0 | None | 0 | 0 | 0.0 | 4 | 0 | 0.0 | |
Unit | µmol/L | 2 | 2 | 100 | None | 0 | 0 | 0.0 | None | 0 | 0 | 0.0 | µmol/L | 1 | 0 | 0.0 | None | 0 | 0 | 0.0 | .333 | 3 | 2 | 66.7 |
PH | ||||||||||||||||||||||||
Lower Limit | None | 0 | 0 | 0.0 | R | 0 | 0 | 0.0 | 7.2 | 7 | 0 | 0.0 | None | 0 | 0 | 25.0 | 7.2 | 35 | 29 | 82.9 | < .001 | 42 | 29 | 69.0 |
Upper Limit | None | 0 | 0 | 0.0 | R | 0 | 0 | 0.0 | 7.5 | 7 | 6 | 85.7 | None | 0 | 0 | 0.0 | 7.6 | 35 | 25 | 71.4 | .654 | 42 | 31 | 73.8 |
PO2 | ||||||||||||||||||||||||
Lower Limit | None | 0 | 0 | 0.0 | R | 0 | 0 | 0.0 | 6.33 | 7 | 0 | 0.0 | None | 0 | 0 | 0.0 | 5.32 | 35 | 29 | 82.9 | < .001 | 42 | 29 | 69.0 |
Unit | None | 0 | 0 | 0.0 | R | 0 | 0 | 0.0 | Kpa | 15 | 6 | 40.0 | None | 0 | 0 | 0.0 | Kpa | 28 | 28 | 100 | < .001 | 43 | 34 | 79.1 |
PCO2 | ||||||||||||||||||||||||
Lower Limit | None | 0 | 0 | 0.0 | R | 0 | 0 | 0.0 | 2.66 | 7 | 6 | 85.7 | 2.5 | 0 | 0 | 0.0 | 2.66 | 35 | 34 | 97.1 | .309 | 42 | 40 | 95.2 |
Upper Limit | None | 0 | 0 | 0.0 | R | 0 | 0 | 0.0 | 8.30 | 7 | 0 | 0.0 | 8.9 | 0 | 0 | 0.0 | 8.00 | 34 | 33 | 97.1 | < .001 | 41 | 33 | 80.5 |
Unit | None | 0 | 0 | 0.0 | R | 0 | 0 | 0.0 | Kpa | 15 | 6 | 40.0 | Kpa | 1 | 1 | 100 | Kpa | 32 | 32 | 100 | < .001 | 48 | 39 | 81.3 |
Bicarbonate | ||||||||||||||||||||||||
Lower Limit | None | 0 | 0 | 0.0 | 10 | 19 | 18 | 94.7 | 10 | 11 | 10 | 90.9 | 10 | 0 | 0 | 0.0 | 10 | 31 | 31 | 100 | .242 | 61 | 59 | 96.7 |
Upper Limit | None | 0 | 0 | 0.0 | 40 | 20 | 19 | 95.0 | 40 | 11 | 10 | 90.9 | 40 | 0 | 0 | 0.0 | 40 | 30 | 29 | 96.7 | .755 | 61 | 58 | 95.1 |
Unit | None | 0 | 0 | 0.0 | mmol/L | 19 | 19 | 100 | mmol/L | 19 | 17 | 89.5 | mmol/L | 1 | 1 | 100 | mmol/L | 29 | 26 | 89.7 | .537 | 68 | 63 | 92.6 |
Neutrophil | ||||||||||||||||||||||||
Lower Limit | 1 | 0 | 0 | 0.0 | 0.5 | 8 | 7 | 87.5 | 1 | 5 | 0 | 0.0 | 1 | 15 | 11 | 73.3 | None | 0 | 0 | 0.0 | .004 | 28 | 18 | 64.3 |
Unit | 109/L | 1 | 0 | 0.0 | 109/L | 8 | 7 | 87.5 | 109/L | 24 | 6 | 25.0 | 109/L | 11 | 10 | 90.0 | None | 0 | 0 | 0.0 | < .001 | 44 | 23 | 52.3 |
Hemoglobin | ||||||||||||||||||||||||
Lower Limit | 70 | 1 | 1 | 100 | 70 | 11 | 1 | 9.1 | 60 | 13 | 4 | 30.8 | 6.5 | 26 | 2 | 7.7 | 60 | 8 | 4 | 50.0 | .010 | 59 | 12 | 20.3 |
Upper Limit | None | 0 | 0 | 0.0 | 190 | 12 | 8 | 66.7 | 200 | 13 | 3 | 23.1 | 20 | 27 | 1 | 3.7 | 200 | 8 | 4 | 50.0 | < .001 | 60 | 16 | 26.7 |
Unit | g/L | 1 | 1 | 100 | g/L | 24 | 22 | 91.7 | g/L | 51 | 51 | 100 | g/L | 11 | 11 | 100 | g/L | 57 | 49 | 86 | .033 | 144 | 134 | 93.1 |
Platelet | ||||||||||||||||||||||||
Lower Limit | 50 | 1 | 1 | 100 | 20 | 3 | 1 | 33.3 | 30 | 13 | 0 | 0.0 | 20 | 26 | 7 | 26.9 | 20 | 14 | 12 | 85.7 | < .001 | 57 | 21 | 36.8 |
Upper Limit | None | 0 | 0 | 0.0 | 1000 | 9 | 0 | 0.0 | 1500 | 14 | 0 | 0.0 | 1000 | 25 | 19 | 76.0 | 1500 | 14 | 13 | 92.9 | < .001 | 62 | 32 | 51.6 |
Unit (109/L) | 109/L | 1 | 0 | 0.0 | 109/L | 25 | 19 | 76.0 | 109/L | 44 | 14 | 31.8 | 1012/L | 10 | 0 | 0.0 | 109/L | 54 | 0 | 0.0 | < .001 | 124 | 33 | 26.6 |
aPTT | ||||||||||||||||||||||||
Upper Limit | 100 | 0 | 0 | 0.0 | 120 | 0 | 0 | 0.0 | 70 | 7 | 0 | 0.0 | 120 | 20 | 8 | 40.0 | 70 | 3 | 0 | 0.0 | .110 | 30 | 8 | 26.7 |
Unit | Sec | 1 | 1 | 100 | Sec | 24 | 19 | 79.2 | Sec | 30 | 30 | 100 | Sec | 23 | 13 | 56.5 | Sec | 53 | 53 | 100 | < .001 | 131 | 116 | 88.5 |
PT | ||||||||||||||||||||||||
Upper Limit | None | 0 | 0 | 0.0 | None | 0 | 0 | 0.0 | 20 | 3 | 0 | 0.0 | None | 0 | 0 | 0.0 | 20 | 2 | 0 | 0.0 | 5 | 0 | 0.0 | |
Unit | None | 0 | 0 | 0.0 | None | 0 | 0 | 0.0 | Sec | 25 | 22 | 88.0 | None | 0 | 0 | 0.0 | Sec | 56 | 55 | 98.2 | .085 | 81 | 77 | 95.1 |
INR | ||||||||||||||||||||||||
Upper Limit | 5 | 0 | 0 | 0.0 | 6.0 | 1 | 0 | 0.0 | None | 0 | 0 | 0.0 | 4.5 | 22 | 9 | 40.9 | 3 | 1 | 1 | 100 | > .999 | 24 | 9 | 37.5 |
Comparing the three outcomes based on socio-demographic groups
Correct answers of upper and lower limits and units of critical values | There is a delay in reporting critical laboratory values | Satisfied with the way a staff would report critical laboratory values | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
Median | (IQR) | p | Yes | No | I don’t know | p | Yes | No | I don’t know | p | |
Hospital | < .001 | .112 | .002 | ||||||||
A | 0.0 | (0) | 4 | 49 | 4 | 42 | 8 | 7 | |||
B | 2.0 | (12) | 22 | 57 | 6 | 75 | 4 | 8 | |||
C | 0.0 | (3) | 31 | 106 | 12 | 132 | 16 | 4 | |||
D | 0.0 | (1) | 12 | 76 | 7 | 81 | 9 | 6 | |||
E | 3.0 | (12.75) | 29 | 103 | 6 | 129 | 8 | 1 | |||
Unit | < .001 | .090 | < .001 | ||||||||
Microbiology | 0.0 | (0) | 22 | 77 | 9 | 96 | 9 | 5 | |||
Hematology | 3.0 | (4) | 38 | 124 | 6 | 155 | 11 | 3 | |||
Biochemistry | 7.0 | (18) | 19 | 91 | 8 | 107 | 9 | 3 | |||
Histopathology | 0.0 | (0) | 10 | 29 | 7 | 29 | 8 | 10 | |||
Immunology | 0.0 | (0) | 1 | 22 | 2 | 18 | 4 | 3 | |||
Virology | 0.0 | (0) | 6 | 31 | 0 | 33 | 3 | 1 | |||
Molecular genetics | 0.0 | (0) | 0 | 5 | 0 | 5 | 0 | 0 | |||
Reception | 0.0 | (0) | 1 | 5 | 1 | 6 | 0 | 1 | |||
Gender | .094 | 0.015 | .462 | ||||||||
Male | 0.0 | (3) | 27 | 162 | 9 | 177 | 16 | 7 | |||
Female | 0.0 | (5) | 70 | 229 | 26 | 281 | 29 | 19 | |||
Age | .006 | .085 | .123 | ||||||||
Below 30 years | 0.0 | (3) | 41 | 113 | 12 | 151 | 9 | 8 | |||
30–45 years | 0.0 | (3) | 43 | 209 | 21 | 227 | 31 | 17 | |||
46–55 years | 1.0 | (4) | 10 | 36 | 2 | 44 | 4 | 1 | |||
Over 55 years | 3.0 | (6) | 4 | 32 | 0 | 36 | 1 | 0 | |||
Nationality | < .001 | < .001 | < .001 | ||||||||
Kuwaiti | 0.0 | (5) | 43 | 121 | 23 | 142 | 30 | 17 | |||
Non-Kuwaiti | 0.0 | (2) | 55 | 269 | 11 | 315 | 15 | 9 | |||
Profession | < .001 | .030 | < .001 | ||||||||
Doctor | 0.0 | (1) | .099 | 6 | 46 | 8 | .002 | 40 | 12 | 8 | .730 |
Assistant register | 0.0 | (0) | 2 | 2 | 3 | 3 | 2 | 2 | |||
Register | 0.0 | (1) | 0 | 21 | 3 | 17 | 4 | 3 | |||
Senior register | 0.0 | (4) | 1 | 12 | 2 | 11 | 3 | 1 | |||
Specialist | 0.0 | (2) | 0 | 7 | 0 | 3 | 2 | 2 | |||
Senior specialist | 0.0 | (0) | 0 | 3 | 0 | 3 | 0 | 0 | |||
Consultant | 2.0 | (7) | 3 | 1 | 0 | 3 | 1 | 0 | |||
Technician | 0.0 | (4) | .278 | 92 | 343 | 27 | .475 | 417 | 33 | 18 | .039 |
Assistant practitioner | 0.0 | (11.25) | 2 | 24 | 2 | 27 | 0 | 1 | |||
Practitioner | 0.0 | (2) | 4 | 27 | 3 | 29 | 3 | 2 | |||
Senior practitioner | 0.0 | (3) | 4 | 13 | 2 | 14 | 4 | 2 | |||
Assistant technician | 0.0 | (3.75) | 9 | 12 | 1 | 19 | 3 | 0 | |||
Technician | 0.0 | (4) | 50 | 180 | 13 | 228 | 12 | 7 | |||
Senior technician | 3.0 | (7) | 8 | 27 | 2 | 30 | 6 | 1 | |||
Specialist | 0.0 | (3) | 7 | 26 | 1 | 31 | 2 | 2 | |||
Senior specialist | 0.5 | (3) | 7 | 34 | 3 | 38 | 3 | 3 | |||
Position | .116 | .049 | < .001 | ||||||||
Head of department | 0.0 | (6) | 1 | 4 | 0 | 3 | 2 | 0 | |||
Head of unit | 0.0 | (2) | 2 | 6 | 0 | 6 | 1 | 1 | |||
Laboratory doctor | 0.0 | (1) | 3 | 37 | 8 | 32 | 9 | 7 | |||
Head of laboratory technicians | 0.0 | (2) | 5 | 9 | 1 | 10 | 3 | 2 | |||
Technician | 0.0 | (4) | 86 | 320 | 26 | 395 | 26 | 16 | |||
There is a delay in reporting critical laboratory values | .049 | < .001 | |||||||||
Yes | 0.0 | (4) | 75 | 17 | 6 | ||||||
No | 0.0 | (4) | 362 | 21 | 8 | ||||||
I don’t know | 0.0 | (4) | 17 | 6 | 12 | ||||||
Satisfied with the way a staff would report critical laboratory values | .001 | ||||||||||
Yes | 0.0 | (4) | |||||||||
No | 0.0 | (2) | |||||||||
I don’t know | 0.0 | (0) |