Is this a critical, panic, alarm, urgent, or markedly abnormal result?

Medical laboratories often produce clinically unexpected results that require timely clinical evaluation because they herald an imminent life-threatening condition or major clinical deterioration. Laboratories therefore need to proac-tively identify and report such results sooner than would routinely occur, and have policies and procedures that minimize the possibility of patient harm due to delayed clinical awareness. Since Lundberg's first description of so-called panic values (1), a variety of other terms have appeared in the literature, for example: urgent, critical, acute, alert, emergent, abnormal, markedly or significantly abnormal, clinically significant, vital, red-orange-yellow zone values, and various combinations thereof. Most of these definitions are reworded alternatives of Lundberg's original description (2, 3). Two recent literature reviews emphasize the need for an agreed terminology to assist global harmonization of the laboratory management of such test results (4, 5). Current definitions focus on the degree of result abnormality, timeliness of communication, and likely patient outcomes (e.g., mortality , morbidity) rather than on the risk to patient safety. Although it is true that unexpected results requiring urgent reporting are often very abnormal, it is not always true that such results represent imminent high risk to patient safety and well-being; examples include high creatinine and chronic elevation of troponin concentrations in stable chronic renal failure and long-term hemodialysis patients, respectively. In our view, categorizing unexpected urgent results on the basis of the magnitude of their abnormality does not allow for individual patients in specific clinical circumstances for whom slightly or moderately abnormal results, or too-rapid normalization of results, suggest impending high risk to their well-being, or for those patients with stable chronic conditions in whom very abnormal results do not pose imminent risk of significant clinical deterioration. Another shortcoming of existing terms is that they often combine results that represent different degrees of risk to patient safety and thus may lead to patient harm due to alert fatigue. From these considerations, it is clear that none of the currently used terms adequately reflect the core attribute of such results. For example, the most common term, " critical result, " does not identify the characteristic that is critical. In our view, the primary attribute of such results is that they represent high and imminent risk to patient safety and well-being. Therefore we propose a clinically more appropriate terminology that emphasizes the degree of risk to patients. We propose to differentiate two risk categories. Critical-risk result is defined as …