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|Title:||An evidence- and risk-based approach to a harmonized laboratory alert list in Australia and New Zealand.|
|Authors:||Campbell, Craig A;Lam, Que T;Horvath, Andrea R|
|Affiliation:||NSW Health Pathology, Department of Clinical Chemistry and Endocrinology, Prince of Wales Hospital, Sydney, NSW 2031, Australia|
Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
Department of Pathology, Austin Health, Heidelberg, Victoria, Australia
NSW Health Pathology, Department of Clinical Chemistry and Endocrinology, Prince of Wales Hospital, Sydney, NSW, Australia
|Citation:||Clinical chemistry and laboratory medicine 2018; online first: 19 April|
|Abstract:||Individual laboratories are required to compose an alert list for identifying critical and significant risk results. The high-risk result working party of the Royal College of Pathologists of Australasia (RCPA) and the Australasian Association of Clinical Biochemists (AACB) has developed a risk-based approach for a harmonized alert list for laboratories throughout Australia and New Zealand. The six-step process for alert threshold identification and assessment involves reviewing the literature, rating the available evidence, performing a risk analysis, assessing method transferability, considering workload implications and seeking endorsement from stakeholders. To demonstrate this approach, a worked example for deciding the upper alert threshold for potassium is described. The findings of the worked example are for infants aged 0-6 months, a recommended upper potassium alert threshold of >7.0 mmol/L in serum and >6.5 mmol/L in plasma, and for individuals older than 6 months, a threshold of >6.2 mmol/L in both serum and plasma. Limitations in defining alert thresholds include the lack of well-designed studies that measure the relationship between high-risk results and patient outcomes or the benefits of treatment to prevent harm, and the existence of a wide range of clinical practice guidelines with conflicting decision points at which treatment is required. The risk-based approach described presents a transparent, evidence- and consensus-based methodology that can be used by any laboratory when designing an alert list for local use. The RCPA-AACB harmonized alert list serves as a starter set for further local adaptation or adoption after consultation with clinical users.|
critical risk result
|Appears in Collections:||Journal articles|
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