Theoretical study on the critical index of rock burst stress monitoring in coal seam drilling.

Rock burst disasters severely restrict the safe and efficient mining of coal. The fundamental cause of their occurrence is the concentration of stress within the coal mass. Stress monitoring in coal seam drilling is widely used as an effective method for rock burst monitoring. However, how to scientifically and reasonably set the critical values of early warning indicators that match the conditions of each mine has always been a key issue restricting the accurate prediction of rock burst by the drilling stress method. This paper adopts a method combining theoretical analysis and field practice to conduct research on the critical values of drilling stress early warning indicators. Based on perturbation response instability theory, a mechanical model for the occurrence of impact ground pressure has been established. Based on the instability theory of disturbance response, a mechanical model for the occurrence of impact ground pressure has been established, leading to the derivation of the expression for the near-field critical stress of impact ground pressure events. The theoretical formula for the critical value of drilling stress early warning indicators was obtained based on the difference between the critical stress of rock burst occurrence and the actual stress in the roadway. This formula includes the mechanical parameters of the coal mass and its propensity for rock burst, roadway support stress, mining depth, stress concentration coefficient, and the initial installation pressure of the stress gauge. They can be determined by the geological and mining technical conditions of each mine. This theoretical formula breaks the uniformity of the critical values for stress warning indicators in various mine drill holes, allowing each mine to scientifically determine its critical value based on its own conditions. This theoretical method has been applied to a high-stress mine in Shanxi, China, and the critical values of drilling stress early warning indicators were obtained. When the monitored stress exceeded the critical value, dynamic phenomena of anchor rod and cable fractures occurred in the roadway roof. The distribution of microseismic events also shifted towards the warning area, and the microseismic monitoring indicators reached the warning values. This confirmed the engineering feasibility of the critical values for drilling stress early warning indicators determined by the theoretical method.

Escalation process of critical values when these cannot be communicated on first attempt: A hospital-wide process improvement project.

OBJECTIVES: Since laboratory critical values reflect such an abnormal pathologic state that there is imminent danger to the patient, it is crucial to deliver the result upon initial call with an escalation process when the initial call cannot occur. In our 8-hospital system, one of the hospitals used the escalation procedure twice as frequently compared with the other hospitals. This work presents hospital-wide quality improvement processes that decreased escalation of critical value calls so as to reach the same proportion of escalated calls compared to other hospitals in the system. METHODS: The laboratory met weekly with leaders of different hospital areas and quality management; they presented the interventions they implemented, and the laboratory monitored their progress. RESULTS: Monitoring and reviewing with providers the importance of critical values decreased temporarily escalated calls from 25% to 18%. Having a dedicated phone to call critical values in each hospital area decreased the calls in a sustained fashion, which now fluctuate between 9% and 14%. Other interventions, including having a dedicated person receiving critical value results, did not decrease escalated critical value calls. CONCLUSIONS: Having a dedicated phone in each hospital area that receives the initial critical value call simplifies and standardizes the process.

Web-accessible critical limits and critical values for urgent clinician notification.

OBJECTIVES: To survey the World Wide Web for critical limits/critical values, assess changes in quantitative low/high thresholds since 1990-93, streamline urgent notification practices, and promote global accessibility. METHODS: We identified Web-posted lists of critical limits/values at university hospitals. We compared 2023 to 1990-93 archived notification thresholds. RESULTS: We found critical notification lists for 26 university hospitals. Laboratory disciplines ranged widely (1-10). The median number of tests was 62 (range 21-116); several posted policies. The breadth of listings increased. Statistically significant differences in 2023 vs. 1990 critical limits were observed for blood gas (pO2, pCO2), chemistry (glucose, calcium, magnesium), and hematology (hemoglobin, platelets, PTT, WBC) tests, and for newborn glucose, potassium, pO2, and hematocrit. Twenty hospitals listed ionized calcium critical limits, which have not changed. Fourteen listed troponin (6), troponin I (3), hs-TnI (3), or troponin T (2). Qualitative critical values expanded across disciplines, encompassing anatomic/surgical pathology. Bioterrorism agents were listed frequently, as were contagious pathogens, although only three hospitals listed COVID-19. Only one notification list detailed point-of-care tests. Two children's hospital lists were Web-accessible. CONCLUSIONS: Urgent notifications should focus on life-threatening conditions. We recommend that hospital staff evaluate changes over the past three decades for clinical impact. Notification lists expanded, especially qualitative tests, suggesting that automation might improve efficiency. Sharing notification lists and policies on the Web will improve accessibility. If not dependent on the limited scope of secondary sources, artificial intelligence could enhance knowledge of urgent notification and critical care practices in the 21st Century.

Critical test result management at Danish hospital laboratories: a national survey.

Critical test results in clinical laboratories are crucial for timely patient care, serving as indicators of potentially life-threatening conditions. Despite their importance, a notable heterogeneity in management practices exists globally. This study investigates the current practices of managing critical results at Danish clinical biochemistry laboratories and identifies areas prone for improvement. A comprehensive online survey was distributed to all 21 Danish clinical biochemistry laboratories regarding their critical result management, including documentation practices, critical limit selection, and quality assurance measures. A total of 17 laboratories (81%) responded. The answers revealed a generally uniform approach to managing critical results, with all laboratories having 24-h reporting, local instructions and using the telephone as communication channel. However, variations were noted in documentation practices and critical limit selection. Notably, 23.5% of the laboratories reported that one out of every ten critical results was not reported, indicating a significant risk of delayed critical results. This is further complicated by the limited use of predefined timeframes for reporting and also, only few laboratories actively monitored response times. The findings emphasize the need for more standardized documentation and evaluation practices to align with international standards and to enhance patient safety. While the laboratories showed a commitment to standardized procedures, the study emphasizes the necessity of a National or Nordic guideline to supplement the ISO 15189:2022. This study is a step towards optimizing critical result management, not only in Danish clinical biochemistry laboratories but also across various laboratory specialties, thereby improving overall laboratory quality, efficiency, and patient safety.

Analysis of Laboratory Critical Values During COVID-19 Pandemic at Tertiary Hospital in Saudi Arabia.

Purpose: One of the most important aspects of post-analytical laboratory activity is the notification of critical results. Therefore, the aim of this study was to illustrate and analyze the prevalence of critical result values of our clinical laboratory investigations during the pandemic stages of coronavirus-19 (COVID-19) and other research pre-pandemic stages. Methods: The seven-month study was conducted between May 2020 and November 2020. Laboratory data of critical results were collected in this retrospective cohort. Results: In total, 221,384 routine tests and 84,451 STAT tests were performed in our clinical laboratory. Of the 3183 (1.44%) tests result was identified as having Critical values, consisting of 2220 (69.74%) and 963 (30.25%) tests in biochemistry and hematology assays. Among the tests with critical values, 39.6% of which were from emergency department (ED) as STAT testing (1262) and 60.3% (1921) as TAT testing. Testing was found in routine inpatients and outpatients, 58% and 2.3%, respectively, and the most frequent parameter notified was sodium. Conclusion: In our practice, we observed that the higher level of frequency of critical values results is related to inpatients, contradicting several researchers reporting that the higher percentages of critical values were from ED.

Critical values notification: A nationwide survey of practices among clinical laboratories across Nigeria.

Background: Critical value notification (CVN) entails notifying doctors or other laboratory users of aberrant laboratory results that threaten the patient's life and of any values for which reporting delays could negatively impact the patient's health. Critical value notification practices in clinical laboratories in Nigeria and sub-Saharan Africa are largely unknown. Objective: We conducted a nationwide survey to obtain baseline information on CVN practice by Nigeria's laboratories. Methods: This cross-sectional study was conducted among purposively selected secondary- and tertiary-tier, public and private clinical laboratories across northern and southern Nigeria between October 2015 and December 2015. Consenting senior laboratory staff completed and returned a structured questionnaire, that gathered data on respondents' demographics, designations, and institutional characteristics and practices regarding CVN. Results: One hundred and thirty-four laboratories responded to the questionnaires. Only 69 (51.5 %) laboratories practised CVN; only 23 (33.3%) had existing written policies guiding the practice. Most (43; 62.3%) laboratories use similar critical values (CVs) for adult and paediatric populations. Most laboratories (27; 39.1%) obtained their CVs by combining published literature and local opinions from stakeholders. Physical dispatch (42; 60.9%) followed by telephone calls (38; 55.1%) were the most common means of notification. Private laboratories, compared with public hospital laboratories, were likelier to have separate paediatric CV lists (p = 0.019) and practise telephone notifications (p < 0.001). Conclusion: Critical value notification practices vary and are often suboptimal in many clinical laboratories in Nigeria, which is exacerbated by the absence of guiding policies and national recommendations for post-analytical procedures. What this study adds: This study provides baseline information on CVN practice by Nigeria's laboratories. The study explores the causes of practice variations that can serve as a foundation for enhancing critical reporting and post-analytical services, particularly in clinical laboratories in sub-Saharan Africa.

Introducing a land use-based weight factor in regional health risk assessment of PAHs in soils of an urban agglomeration.

The high heterogeneity of land uses in urban areas has led to large spatial variations in the contents and health risks of polycyclic aromatic hydrocarbons (PAHs) in soils. A land use-based health risk assessment (LUHR) model was proposed for soil pollution on a regional scale by introducing a land use-based weight factor, which considered the differences in exposure levels of soil pollutants to receptor populations between land uses. The model was applied to assess the health risk posed by soil PAHs in the rapidly industrializing urban agglomeration of Changsha-Zhuzhou-Xiangtan Urban Agglomeration (CZTUA). The mean concentration of total PAHs (∑PAHs) in CZTUA was 493.2 µg/kg, and their spatial distribution was consistent with emissions from industry and vehicles. The LUHR model suggested the 90th percentile health risk value was 4.63 × 10-7, which was 4.13 and 1.08 times higher than those of traditional risk assessments that have adopted adults and children as default risk receptors, respectively. The risk maps of LUHRs showed that the ratios of the area exceeding the risk threshold (1 × 10-6) to the total area were 34.0 %, 5.0 %, 3.8 %, 2.1 %, and 0.2 % in the industrial area, urban green space, roadside, farmland, and forestland, respectively. The LUHR model back-calculated the soil critical values (SCVs) for ∑PAHs under different land uses, resulting in values of 6719, 4566, 3224, and 2750 µg/kg for forestland, farmland, urban green space, and roadside, respectively. Compared with the traditional health risk assessment models, this LUHR model identified high-risk areas and drew risk contours more accurately and precisely by considering both the spatial variances of soil pollution and their exposure levels to different risk receptors. This provides an advanced approach to assessing the health risks of soil pollution on a regional scale.

Method comparison between Alinity hq and Sysmex XT-4000i in an emergency laboratory.

Due to technological advancements, haematology analysers are becoming increasingly more complex. Before introducing new analyzers, laboratories must compare the agreement between the new and the old instruments. This study aimed to quantify the method agreement between Sysmex XT-4000i and Alinity hq analysers in order to establish whether they can be used interchangeably. A total of 415 complete blood counts (CBC) from adult patients of the Emergency Clinical County Hospital of Târgu Mureș, Romania, were analysed within 4 h from the collection on Sysmex XT-4000i (considered the reference method), then on Alinity hq. Statistical analysis consisted of outlier removal, Spearman Correlation, Bland-Altman test, and Passing-Bablok regression. For each CBC parameter, the analytical difference between methods was compared with the Reference Change Value (RCV) at medical decision levels (MDL). Despite using different technologies, the instruments have a good agreement regarding cell differentiation and counting. Cell counting and haemoglobin measurement showed a good agreement at all (Medical Decision Limits) MDLs. The analytical difference between methods surpassed the (Reference Change Value) RCV with 1.2% at the 14% MDL of HCT and with 0.2% at the 100 fL MDL of MCV. This study can not tell whether Sysmex or Alinity is superior, only if the two methods agree. The poorer agreement observed for RBC indices, especially MCHC, suggests an accumulation of differences caused by the different working principles of the two methods. However, it is reasonable to assume that such small differences will not affect clinical decision-making and patient outcome.

Total Analytical Error and Measurement Uncertainty for Analytical Performance Evaluation and Determination of Gray Zones of Glucose Critical Value Limits.

OBJECTIVE: Total analytical error (TAE) and measurement uncertainty (MU) are important approaches to evaluating and improving the quality of measurement procedures. This study evaluates glucose analytical performance (AP) according to TAE and MU and calculates gray zones of glucose critical value limits. METHODS: Using TAE and MU values, AP was evaluated according to 5 different analytical performance specifications (APS) and the gray zones of critical value limits were calculated. The number of patients in these zones was compared. RESULTS: TAE was higher than MU at all 3 levels. The AP for the low glucose level was poor. The number of patients in the gray zones was statistically higher in the TAE groups than in the MU groups (P < .05). CONCLUSION: TAE and MU values can be used to evaluate the AP of glucose measurement as well as to evaluate the compliance of patient results with decision limits by creating gray zones.

Criteria for placental examination for obstetrical and neonatal providers.

Pathologic examination of the placenta can provide insight into likely (and unlikely) causes of antepartum and intrapartum events, diagnoses with urgent clinical relevance, prognostic information for mother and infant, support for practice evaluation and improvement, and insight into advancing the sciences of obstetrics and neonatology. Although it is true that not all placentas require pathologic examination (although alternative opinions have been expressed), prioritization of placentas for pathologic examination should be based on vetted indications such as maternal comorbidities or pregnancy complications in which placental pathology is thought to be useful for maternal or infant care, understanding pathophysiology, or practice modifications. Herein we provide placental triage criteria for the obstetrical and neonatal provider based on publications and expert opinion of 16 placental pathologists and a pathologists' assistant, formulated using a modified Delphi approach. These criteria include indications in which placental pathology has clinical relevance, such as pregnancy loss, maternal infection, suspected abruption, fetal growth restriction, preterm birth, nonreassuring fetal heart testing requiring urgent delivery, preeclampsia with severe features, or neonates with early evidence of multiorgan system failure including neurologic compromise. We encourage a focused gross examination by the provider or an attendant at delivery for all placentas and provide guidance for this examination. We recommend that any placenta that is abnormal on gross examination undergo a complete pathology examination. In addition, we suggest practice criteria for placental pathology services, including a list of critical values to be used by the relevant provider. We hope that these sets of triage indications, criteria, and practice suggestions will facilitate appropriate submission of placentas for pathologic examination and improve its relevance to clinical care.

Baseline assessment of staff perception of critical value practices in government hospitals in Kuwait.

BACKGROUND: Notification of laboratory-determined critical values is key for effective clinical decision making and is thus a consequential step in a patient's health care and safety. This study presents an overview of staff reporting policies and procedures concerning critical values in Kuwaiti governmental hospitals. METHODS: A cross-sectional descriptive study design was adopted. Study subjects were affiliated with laboratories from five government hospitals (four general and one sub-specialty hospital). All laboratory staff in every hospital were included. The Statistical Package for the Social Sciences (version 23) was used to analyse the collected data at a significance level of ≤ 0.05. Quantitative data analysis included univariate descriptive (means, medians, standard deviations, frequencies, percentages) and bivariate (chi-squared, ANOVA and Kruskal-Wallis tests) analyses. These analyses provided associations between participating hospitals and staff perceptions towards the policies and procedures surrounding critical values. RESULTS: 559 questionnaires were returned, a total response of 30.5% after those of 79 phlebotomists were excluded (eligible sample size n = 1833). The notification of critical values differs between participated laboratories in delivering protocol and time duration. Linked protocols between laboratories did not exist regarding policies and guidelines for applying the same procedures for critical value notification. There are differences in critical value limits among the participating laboratories. CONCLUSION: This study is the first to survey laboratory staff perceptions of critical value practices in Kuwaiti government hospitals. Enhancing critical value reporting and policy is crucial for improving patient safety and to develop high-quality health services. The findings of this study can help policy makers implement future intervention studies to enhance laboratory practices in the area of critical values and improve patient safety and the quality of government hospital systems.

Valor de creatinina, potasio y glicemia como predictores de eventos adversos del síndrome coronario agudo

Introducción: En los últimos años la definición de síndrome coronario agudo, ha englobado las diferentes formas de presentación de la cardiopatía isquémica aguda. A pesar de las posibilidades terapéuticas actuales presenta todavía una morbimortalidad elevada y no se cuenta con herramientas de laboratorio para sospechar de manera precoz las complicaciones. Objetivo: Determinar el valor de los cambios de la concentración de creatinina, potasio y glicemia como predictores de eventos adversos del síndrome coronario agudo. Métodos: Se realizó un estudio analítico de cohorte. La muestra estuvo constituída por 124 pacientes. Se confeccionó un formulario donde se recogieron los datos a partir de las historias clínicas, las variables fueron: grupos de edades, sexo, color de piel, diagnóstico, evento adverso, creatinina, potasio y glicemia. Resultados: Predominó el grupo de edad de más de 60 años, el sexo masculino y color de piel blanco. Los principales eventos adversos fueron arritmias y disfunción ventricular izquierda. La creatinina elevada se asoció a disfunción ventricular izquierda, insuficiencia cardíaca y edema agudo del pulmón, la hiperpotasemia con arritmias potencialmente fatales que degeneraron en paro en asistolia y muerte. La hipopotasemia se asoció con arritmias y la hiperglicemia con la recurrencia del episodio isquémico. Conclusiones: La totalidad de los pacientes con valores normales de creatinina, potasio y glicemia no presentaron complicaciones y se demostró su utilidad como predictores de eventos adversos del síndrome coronario agudo.

Introduction: In recent years, the definition of acute coronary syndrome has encompassed the different forms of presentation of acute ischemic heart disease. Despite the current therapeutic possibilities, it still presents a high morbidity and mortality and there are no laboratory tools to suspect complications early. Objective: To determine the value of the changes in the concentration of creatinine, potassium and glycemia as predictors of adverse events of acute coronary syndrome in patients admitted to Hospital Universitario Manuel Ascunce Domenech in the period from October 2017 to October 2018. Methods: A analytical cohort study. The sample consisted of 124 patients. A form was made where the data were collected from the medical records, the variables were: age groups, sex, skin color, diagnosis, adverse event, creatinine, potassium and glycemia. Results: The age group over 60 years old, male sex and white skin color predominated. The main adverse events were arrhythmias and left ventricular dysfunction. Elevated creatinine was associated with left ventricular dysfunction with heart failure and acute pulmonary edema, hyperkalemia was associated with potentially fatal arrhythmias that degenerated into asystole arrest and death. Hypokalemia was associated with arrhythmias and hyperglycemia with the recurrence of the ischemic episode. Conclusions: All the patients with normal values ​​of creatinine, potassium and glycemia without complications and their usefulness as predictors of adverse events of acute coronary syndrome was demonstrated.

Critical Values in Laboratory Tests of Iranian Patients Referring to Laboratories: A Cross-sectional Study in Kerman.

BACKGROUND: Laboratory services play an important role in optimizing patient care today, and the importance of clinical laboratories is now widely accepted in medical practice. A critical value, originally described by Lundberg more than 30 years ago, refers to an abnormal test result that can lead to a serious life threat if not reported in a timely manner. In this study, we tried to determine the importance of critical values that can lead to a serious life threat with regard to their prevalence and frequency in laboratory tests of Iranian patients. METHODS: In this cross-sectional study, the frequency of critical values in laboratory tests were determined and compared according to the type of laboratory parameter, age, sex, the inpatient/outpatient status, the related clinical ward, recurrence of critical values in the patient's test results, and the sampling working shift in Shahid Bahonar hospital in Kerman, Iran, in 2017 and 2018. RESULTS: Among the tests, 0.2% had critical results. There was a significant relationship between the frequency of critical results with the patients' age (P = 0.002) and sex (P = 0.001) as well as with sampling working shift (P = 0.030) and admission ward (P = 0.001). Among the tests with critical values, the urea test was the most common with 32.2% critical value incidence. CONCLUSION: To maintain patient safety, proper recording of the results in laboratory tests and prompt reporting of critical values to the health care staff before repeating the test should be emphasized.

Prevalence, Association Relation, and Dynamic Evolution Analysis of Critical Values in Health Checkup in China: A Retrospective Study.

Objective: The critical values in health checkup play a key role in preventing chronic diseases and different types of cancer. This study aimed to analyze the prevalence, association relation, and dynamic evolution of critical values in health checkups at a large physical examination center in China. Methods: Herein, we chose 33,639 samples of physical examiners from January 2017 to December 2019. After strict exclusion processes, combined with the critical values in health checkup reporting data, 4,721 participants with at least one critical value were included. We first defined a critical value list for laboratory test, imaging, cervical cancer screening, electrocardiogram, and health checkup informed on site, and then performed a cross-sectional study to analyze the distribution and significance of critical values of 4,721 participants from different views and the association relation of 628 participants with more than one critical value and a retrospective cohort study to analyze the incidence and dynamic evolution of critical values based on 2,813 participants attending the physical examination from 2017 to 2019. Results: A total of 4,721 participants were included in the retrospective study. The prevalence of 10 critical values from 33,639 participants was over 0.6%. The critical values of obesity, hypertension, Glucose_T, Liver_T, Kidney_T, Lipid_T, Urine_T, and Head_CT were significantly increased in men (P < 0.05), whereas the results were the opposite for the Blood_T and Thyroid_US (P < 0.01). The prevalence trend of critical values increased along with age, where the prevalence of men was higher than that of women under 60 years old (P < 0.01), while the prevalence of women increased by four times and exceeded the prevalence of men above 70 years old. Association relation analysis identified 16 and 6 effective rules for men and women, respectively, where the critical values of Urine_T and Glucose_T played the central roles. Furthermore, a retrospective dynamic evolution analysis found that the incidence of new critical values was about 10%, the incidence of persistent critical values was about 50%, and that most of the effective evolution paths tended to no critical values for men and women. Conclusion: In conclusion, this study provides a new perspective to explore the population health status using the critical value reporting data in a physical examination center, which can assist in decision-making by health management at the population level and in the prevention and treatment of various types of cancer and chronic diseases at the individual level.

Missed critical value callbacks due to middleware flaw.

OBJECTIVES: In 2018, our clinical laboratory was alerted to back-to-back plasma sodium critical value callback failures on the same patient, occurring on different shifts and involving different technologists. Therefore, we set forth to investigate the root cause for the critical value callback failures. DESIGN AND METHODS: We conducted a thorough investigation focused on the processes associated with critical value identification and notification for plasma sodium measurement performed on the Siemens Vista. RESULTS: Our investigation uncovered a flaw in the Siemens CentraLink middleware software. A default dark blue bar in the top row of the results review display was determined to obscure the red color which highlights critical values for lab staff identification. Sodium was disproportionately impacted by this flaw, as it is commonly ordered as part of metabolic panels, and is listed first among the panel analytes in the top row of the CentraLink display. Retrospective data review comparing critical callback failure rates for sodium to potassium and hemoglobin confirmed that sodium had significantly higher critical callback failure rates than these other analytes. After alerting the product manufacturer, Siemens programmed the CentraLink display so that the top row was blank and devoid of patient results, so that the blue color in the top row would no longer obscure the red visual cue of a patient's critical result. Sodium critical value callback failures were reduced to 0% after this middleware display correction. CONCLUSIONS: Middleware design flaws can have unexpected consequences on clinical laboratory operations. We encourage clinical laboratories to closely examine user interfaces utilized by laboratory staff, and be wary of potential impacts that the display format may have on results reporting.

Defining and Reporting on Critical Values in Genetics: A Laboratory Survey.

BACKGROUND: Although an obvious critical value in metabolic genetics would be ammonia, it is more challenging to define critical values in molecular genetics and cytogenetics. The objective of this study was to survey genetic laboratories in Ontario, Canada, to determine whether different centers considered similar results as critical and thus potentially deserving of a different reporting process. METHODS: An online 11-question survey was emailed to Ontario laboratory directors, and the results were analyzed. RESULTS: The response rate was 82% (9/11). Cytogenetics and molecular genetics services were each provided by 7 of the 9 centers, with 3 centers providing biochemical/metabolic genetics services and 1 providing maternal marker serum screening services. The case type (e.g., prenatal, newborn, or expedited by the ordering physician) was one factor. Quantitative fluorescence PCR for autosomal aneuploidy, pathogenic variants in both prenatal and postnatal settings, and oncological results were considered critical cytogenetics results. Pathogenic prenatal cases, indeterminate results, and unexpected results were considered more critical for molecular genetics. Critical results were more likely to prompt a telephone call or email to the ordering physician. CONCLUSION: Ontario genetics laboratories tended to have similar reporting processes for critical results. Both the types of cases and the pathogenicity of the result define what values are considered critical.

Assessment of the State of Economic Security in Russia Using the Example of the Unemployment Rate Indicator: Fractal Analysis Method.

The article proposes methodological approaches to the verification of indicators of the state of the country's economic security using the method of fractal analysis. Fractal analysis technologies make it possible to determine the nature and dynamics of changes in the indicator, to verify its values (indicative or critical), and also to reveal the rate at which these states are reached on the time horizon of statistical observations. The unemployment rate indicator is selected as an example.

Critical values in cytology.

The timely reporting of critical values, or values that may be life-threatening if immediate action is not taken, is essential to patient care and safety. Although some guidelines exist for critical diagnoses in cytology, not all laboratories have a specific list of diagnoses that should be considered critical, and the very existence of cytology "critical values" has been called into question. Here we propose a pragmatic system for determining cytology critical values and report our laboratory's critical value list, formulated based on a review of the medical literature regarding clinical urgency and other institutions' cytology critical value lists.

Improving Critical Value Notification through Secure Text Messaging.

BACKGROUND: To improve communication between clinical providers and the laboratory, we recently implemented secure text messaging for our critical value notifications. This was done to communicate laboratory critical values (CV) to providers faster so changes to patient care could be done faster. Our previous method of communicating CV to providers was paging and relied on a call back to receive the critical value. METHODS: We implemented delivery of CV through a secure texting application in which the CV was directly communicated to the provider on their smart phone device. RESULTS: The mean pre-implementation turnaround time (TAT) was 11.3 minutes (median: 7 minutes, range: 0 - 210 minutes). The mean post- secure text messaging implementation TAT was 3.03 minutes (median: 0.89 minutes, range: < 1 - 95 minutes).When comparing pre- and post-implementation, there was a significant reduction in the TAT from using secure text messaging (p < 0.001). Of the 234 surveys sent out, 81 providers responded (35%). Of these responses, 85% reported that critical value notification by secure text messaging has increased their efficiency and 95% reported that critical value notification is more effective than a pager-phone-call based system. 83% of providers reported that they were able to provide better, faster care to their patients. CONCLUSIONS: Using secure text messaging (STM) to deliver critical values significantly reduces the CV TAT. Furthermore, providers noted they preferred to receive CV notifications through STM and reported that they were able to provide more effective care to their patients.