GRADUATE MEDICAL EDUCATION

POLICIES & PROCEDURES

THD Internal Medicine Clinic Policy and Procedure for Reporting Critical Lab Values
 Policy Number:27
Date Issued:07/2003
Prior Revision Date:
  Date Revised: 08/2009
PURPOSE To define the Internal Medicine policy for the Jackson Internal Medicine Clinic policy for Reporting Critical Lab Values by the Internal Medicine residents.
SCOPE Applies to all interns and residents (hereafter will be referred to as trainees) in the Internal Medicine training program on the Texas Health Presbyterian Hospital Dallas campus.
PROVISIONS

1. Labs:

  • Reviewed each day by the RN when the results arrive in the clinic.
  • Any value designated as “Critical Value” by the Texas Health Presbyterian Hospital Dallas Lab is immediately reported to the resident or his/her coverage.
  • Any “Critical Value” reported by the Lab at night is called to the Medical Director or the Internal Medicine Resident on call.
  • Unless otherwise instructed, nurses will report the following values to the residents or his/her coverage:
    • HgB less than 10,  that has decreased by more than 2 grams since the last HgB
    • WBC greater than 14,000 or less than 2,000
    • Platelet count less than 50,000
    • Sodium less than 130
    • Sodium greater than 150
    • Potassium less than 3.2
    • Potassium greater than 6.0
    • New elevation in creatinine by 1.0 or more
    • Elevation in LFT’s by three times normal
    • Calcium less than 7.5 or greater than 11.0
    • Positive cultures

2. X-rays:

  • Reviewed by nurses daily and placed in the patients chart for the resident to sign
  • Nurse will call the resident immediately for:
    • Pneumonia
    • Fracture
    • Pleural Effusion
    • Marked CHF by CXR

3. Non-invasive Cardiology:

  • Nurses review all echocardiograms, stress echo’s, and stress sestamibi exams that come to the clinic and place them in the patient’s chart for the resident to sign.
  • Nurses notify the resident immediately for:
    • Positive Stress Test
MARK FELDMAN, M.D.
Chairman, Internal Medicine
Program Director, Internal Medicine 		BRUCE BOUGENO Vice President, Medical Staff Affairs