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Consolidation of Testing at LifeLabs’ Burnaby Reference Laboratory (BRL) & Handling of Critical Results after hours

​LifeLabs has recently reached an important integration milestone - All former BC Biomedical Patient Service Centres (PSCs) have now been converted to LifeLabs Medical Laboratories’ Systems.  Chemistry and hematology laboratory testing in Vancouver’s lower mainland have also been consolidated at the BRL testing facility.  This involves patient samples coming from 80 PSCs, with 65% from north of the Fraser (Vancouver including North Van, Richmond, Burnaby, New West, Coquitlam, POCO, Port Moody) and the remainder south of the Fraser (Surrey, Delta, Abbotsford, Chilliwack, Pitt Meadows, Langley, White Rock).  Due to the geography and logistics resulting in patient samples arriving later than usual to BRL, some testing shall be performed later in the evening or even early hours of the morning.  LifeLabs adheres to the BC College of Physicians and Surgeons Professional Standards and Guidelines and the Guiding Ethical Principles, CMA Code of Ethics which mandates our responsibilities to the patient and requires that we consider first the well-being of each patient.  Therefore, LifeLabs endeavors to deliver all critical results (based on “Critical Values Consensus Statement” Guidelines developed by BCALP, Hematology Section, as soon as these are discovered by the laboratory.  This may result in patient’s physician being called during early hours of the morning with critical results.  BCALP hematologic critical values are noted below:  

Analyte    Threshold

Hemoglobin, g/L    < 50
> 230 (except neonates)

WBC X 109/L    < 1
> 100 (adults and children)
Platelets X 109/L    < 20
Neutrophils X 109/L    < 0.5
Blood Film    Malaria parasites, falciparum or unspeciated
Prothrombin time, INR    > 6
Fibrinogen, g/L    < 0.6

At LifeLabs, we feel “critical results” for outpatients need to have a bit more flexibility to allow for more lead time for Healthcare Providers to deal with these abnormalities.  Compared to in-hospital patients, where patients are already in a secure/safe environment, these levels can be set lower. Therefore we have made the following modifications to critical levels for adults at LifeLabs:
1)    Hgb =< 60g/L or > 200g/L  (since outpatients may take longer time to receive appropriate therapy, compared to in-patients)
2)    Hematocrit <0.18 or >0.70
3)      Platelets  =< 20 or >1,500 x109/L
4)    Blast cells – new findings or  significant change (esp increased)
5)    Neutrophils <0.6 or >99.9 x109/L
6)    Lymphocyte >300 x109/L
7)    INR >=5.0
8)    PTT >=70 s
9)    Fibrinogen <1 g/L
We request each Healthcare Providers to ensure your after-hours contact numbers (home or cell phone) are identified on the requisition or made available to Lifelabs, so we may communicate critical results to you in a timely manner, so that each such patient is handled appropriately and in compliance with the BC College of Physicians and Surgeons Professional Standards and Guidelines, as referenced above.

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