摘要目的 对临床实验室危急值的历史数据进行统计分析,探讨建立合理的危急值报告制度.方法 横断面研究.统计福建医科大学附属第一医院检验科2008年11月至2012年10月危急值63 794件,计算危急值的年内发生率、项目分布及病区分布；比较危急值项目信息化、个性化报告前后的及时率和漏报率；对比门诊危急值报告流程改造前后的临床响应时间.结果 福建医科大学附属第一医院每年危急值报告1.5万～1.8万件,占年检测数1.53％ (63 794/4 166 267),主要来源于住院患者(约占80％),以PLT、K+、APTT出现的频率最高；危急值分布不平均,集中分布于ICU、血液科、急诊科及肝病中心等病区；电话报告危急值耗时3～8 min(中位数5 min),漏报率7.53％ (949/12 596),信息化发送危急值报告仅需5～10s,未见漏报；个性化报告使血液科、肝病中心的危急值报告工作量分别由13.85％、12.77％降为11.24％、8.43％；采用新的门诊危急值流程(班内及班外不同模式),危急值临床响应时间由20 min降为7 min.结论 实现危急值信息化管理提高危急值报告效率和准确率.建立合理可行的危急值报告制度,可以减少错误发生.

abstractsObjective By analysing the historical data of critical laboratory values,the development of practicable critical values reporting system was investigated.Methods There were totally 63 794 critical values reported by the Department of Laboratory Medicine of the First Affiliated Hospital of Fujian Medical University from Nov,2008 to Oct,2012.We analysed the yearly incidence,the analytes and the distribution of critical values; we also compared the report timeliness and false rejection rate before and after the informationization and differential management of the critical values report; Meanwhile we compared the clinician response time before and after the implementation of the new out-patients critical values reporting flow.Results There were 15 000-18 000 critical values reports yearly accounting for 1.53％ (63 794/ 4 166 267) of the total results.Most of the critical values reports were from in-patients (about 80％),and the top 3 analytes of critical values were PLT,K + and APTT.The critical values reports were not uniformly distributed the ICU Department,Hematology Department,Emergence Department and Liver Center were concentrated distribution departments.It took 3-8 minutes (median:5 min) for staff in the Department of Laboratory Medicine to call the clinician/nurse after critical values were known and the false rejection rate was 7.53％ (949/12 596).However,it just took 5-10 s to notify the clinician/nurse via the electronic alert system,and the false rejection rate was 0.There was a significant decrease of critical values reports about the in-patients in the Hematology Department and the Liver Center since the definition of critical values in these two departments was slightly modified,that was from 13.85％ to 11.24％ (the Hematology Department) and from 12.77％ to 8.43％ (the Liver Center),respectively.And since the new out-patients critical values reporting flow was adopted (different reporting flows during office hours and out of hours),the clinician response time decreased from 20 min to 7 min.Conclusions The informationization of the critical values report is helpful to improve work efficiency and the accuracy rate.And the hospital should make practicable critical values reporting system on the basis of individual institutional needs,especially the outpatient critical values reporting flow.