Do panic values cause panic? Reporting of critical laboratory results in a tertiary hospital in Kenya

Prompt communication of critical laboratory results is important for patient safety. Various standardisation bodies have proposed procedures for handling critical results, with notification parameters outlined. However, few studies exist in low- and middle-income countries (LMIC) to document how critical results are handled. We tracked 12 types of laboratory tests over a three-week period in December 2018 and documented if and how critical test results were communicated, the time-frame for communication, and evidence of action taken on the results. During the period, 331 of 5,500 (6.1%) test results were identified as critical. Only 71 (21%) of the critical results were documented as having been communicated to the destination departments. Of the communicated results, clinicians were unaware of 21 (29.6%). Of the 12 test types, critical results were only communicated for three tests namely: potassium, haemoglobin and positive malaria tests. Communication of critical results to inpatient settings was significantly higher than to outpatient settings (p <0.05), with communication rates decreasing as the week progressed, during weekends and around holidays. The observed poor communication of critical results in an LMIC setting raise significant patient safety concerns. Laboratories in these settings need to adhere to international standards, like ISO 15189:2009, to assure safe practice. Training of staff, establishment of standard operating procedures guiding these results, and implementation of fail-proof critical result dissemination mechanisms are essential. It is important that all critical results are communicated within one hour of availability. Implementation of Order Entry and Laboratory systems should be highly considered.