The Clinical Application Of Critical Value Reporting System At A Neonatal Department

Objective：To review the clinical characteristics of neonatal criticalvalues and regularity behind critical value in an effort to provide scientificevidences for continuous improvement of critical value report system.Methods: Retrospective analysis on data collected from July1st，2012to September30，2012was performed; The complete cases of232newborns’330critical value records in the neonatal diagnosis andtreatment center of Children’s hospital affiliated to Chongqing medicaluniversity were reviewed. Trace-back investigate the Clinical features ofthese newborn, including gestational age，birth weight，Main diagnosis,prognosis, etc. And calculate the constituent ratio of each critical value items,daily distribution, and clinical response rate, etc.Results:1.There were330critical value records of232neonates，181（54.8%） records occured in neonatal intensive care unit (NICU)，42inPremature infant ward，107(32.4%) in term infant ward. The averagegestational age and birth weight of all the neonates were (36.2±3.37)weeks and (2.53±0.72) kg respectively. 2. Analysis the regularity behind the time of critical value, during theperiod of the investigation, we found that critical value was most likely tohappen in11:00a.m.~11:59a.m.(45records). In particularly, nearly51.8%(171) records occurred in the duty-hour（12:00noon~13:59p.m. and6:00p.m.~7:59a.m. the next day）. Overall, the coagulation function test(Fib≤0.5g/L, PT≥180s or APTT≥240s) was the most common critical valuerecords. It adds up to about38.2%of all the critical value records, followedby electrolytes (14.5%), micro-culture tests(13.0%) and imagingexamination(12.4%), and other diagnostic tests。3.Generally，the clinical response rate of critical value was56.4%（186/330）,blood urea nitrogen(BUN), ECG examination andplasma concentration has had the highest response rate(100%),followed byhypoglycemia(97%), complete blood count (88.9%), imagingtests(78%)，electrolytes（68.8%），micro-culture tests（34.9%）andcoagulation function tests（30.2%）.4. One hundred and sixteen (71.6%) Of all the infants who has criticalvalue record, were cured and discharged,40were given up the treatmentsbecause of too serious condition or socio-economic factor, and26(11.2%)were transferred for further treatment.Effective and timely treatment couldimprove prognosis on these infants who has critical value records, andsocio-economic factor also play an important role. Conclusion：1. Critical values are more likely to happen in premature/low birthweight infants, especially the neonates in NICU. It always occurs the first48h since the time of admission. Coagulation function test was the mostcommon critical value records.2. Take corresponding measures as early as possible for high riskinfants helps to improve the treating effect.3. Periodically analyze and summarize critical value data，using ofunique critical values for neonatal clinical practice within the children’shospital is a tendency to future development. It could improveclinical/laboratory work efficiency and quality.