Critical value, from result to documented call
Flag a panic result, record who was told and when, alert the right people, and keep the evidence NABL assessors ask for.
Lab technicianPathologistRadiologistLab manager / chief pathologistQuality manager (NABH / NABL)
A critical (panic) value is a result that puts the patient at immediate risk, for example potassium 6.8 mmol/L, glucose below 40 mg/dL, or a pneumothorax on a chest film. It must reach a responsible clinician quickly, and the call must be documented. CareList records the call on the order, alerts the people who must know, and keeps the report from being verified until the call is logged.
Who can flag
Flagging needs the diagnostics.process capability: Lab technician, Pathologist, Radiologist, Lab manager / chief pathologist, or a full-access role (administrator, medical director, quality manager). Phlebotomists, radiographers and front office cannot.
The Flag critical value panel appears on the order page:
| Department | Available from | Not available |
|---|---|---|
| Laboratory | Processing onwards | Registered, Sample collected, Received in lab |
| Imaging | Scan done onwards | Registered |
It is never shown on Rejected or Cancelled orders.
Step by step
- Confirm the result. Repeat or re-check it per your SOP.
- Call the referring doctor, the ward in-charge or the patient, and ask for a read-back.
- Open the order (search the accession number, or scan the label from Scan).
- Tap Flag critical value to open the panel.
- In Notified to (name, role), type who you told, for example
Dr Sharma, referring physician. - In Time notified, leave it blank to use now, or enter the actual call time (it cannot be in the future).
- Tap Save critical value call.
The order now shows a red banner: Critical result — notified to … at … by …, with your name. On the list it carries a red Critical badge. If you save again (the panel then reads Update critical value call), the latest call details replace the previous ones, and each save is logged.
Tip: For a full NABL record, also run the Critical Value Communication checklist on the order (Add checklist). It captures the test and result, Result re-checked / repeated before calling, Read-back confirmed by receiver, Within 30 minutes of result and a signature. In the demo it also asks you to accept an attestation statement.
Who is alerted
Saving the call sends an instant notification (in the app, by push, and by email to users who keep Email me alerts on in My account) to every active user in your company with one of these roles, except you:
| Lab order | Imaging order |
|---|---|
| Pathologist, Lab manager / chief pathologist | Radiologist |
| Administrator, Quality manager, Medical director | Administrator, Quality manager, Medical director |
The alert reads Critical value: DX-… patient name – notified to … and opens the order.
Verification block
Mark as verified checks the critical flag. If an order is marked critical but has no recorded notification time, verification stops with:
Record who was notified of the critical result before verifying.
Because the flag and the call are saved together in one form, this normally means the call has simply not been logged yet. Log it, then verify.
Audit trail
Each save writes a diagnostic.critical entry to the Audit log (managers: More → Audit log) with the accession number and who was notified. The order page keeps the receiver, the time and the person who called. The weekly or daily email report includes diagnostics TAT and critical values for the period. See Notifications and reports.
What NABL assessors expect (ISO 15189)
- A defined list of critical intervals per test, agreed with clinicians. Keep it in your SOP. CareList does not hold reference ranges.
- Prompt communication, typically within 30 minutes of the result being available, to a person who can act.
- A record of date and time, who called, who received the call, the result, and a read-back. That is the banner plus the Critical Value Communication checklist.
- Monitoring as a quality indicator: the percentage of critical values communicated on time. The Laboratory Audit (NABL) has the question Critical values communicated within TAT and logged, and the Report Verification & Release checklist asks Critical values communicated and documented.
- Failure handling: if the doctor could not be reached, record the escalation in the checklist comments, and raise a corrective action. See Failed item to corrective action.
Try it
In the demo diagnostic centre, Arjun Nair (serum potassium, creatinine) is a verified order with a logged critical call to Dr Sharma (referring physician). Sign in as tech@diagnostics.test (password password), open Mohan Das (STAT troponin, at Processing) and flag a critical value. Then sign in as pathologist@diagnostics.test to see the alert in Notifications.
See also the help article Turnaround time and critical values.