Author ORCID Identifier

Defense Date


Document Type


Degree Name

Doctor of Philosophy


Health Related Sciences

First Advisor

William Korzun, Ph.D.

Second Advisor

Teresa Nadder, Ph.D.

Third Advisor

Terris Kennedy, Ph.D.

Fourth Advisor

Melissa Jamerson, Ph.D


Critical values are laboratory values that represent a life-threatening condition for which there is a treatment available. Laboratories make immediate notifications to ordering providers when critical values are identified so that they may quickly act to initiate a treatment for their patient. The majority of laboratories apply the inpatient critical value list to the outpatient setting, although there are many differences between an acutely ill inpatient population and an ambulatory outpatient population. The goal of this study was to determine if providers responded to the critical values in the outpatient setting and to determine if there was a difference in outcome indicators when providers responded to notifications and when they did not respond to notifications.

Data for 673 critical value notifications for PT/INR, Digoxin, and Glucose results were collected from Riverside Health System’s five laboratories. Analysis suggested that the inpatient critical value lists and thresholds may not be appropriate to apply to the outpatient setting. In this study of 637 critical value notifications, providers chose not to respond to 25.7% of critical value notifications. Providers were more likely to respond to PT/INR and Digoxin critical value notifications that glucose critical value notifications. None of the cases for either of the three tests that went without a provider response resulted in death or serious harm to a patient, indicating that the critical value thresholds do not meet the definition of a critical value in the outpatient setting. In the future, laboratories should explore the utilization of a different critical value list and thresholds for the outpatient setting based upon patient outcomes.


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