Worthless Wake-up Calls

February 11, 2015
Melissa Young, MD

When is a lab critical value a true critical value? That is the question that needs to be answered so that we can put an end to 5 am phone calls from the lab--to me.

When is a lab critical value a true critical value?  How often have you received a call at 5 in the morning from a lab to tell you that the patient’s glucose is 40? Or that the creatinine is 8? Now granted, these are lab values that are clearly abnormal and could be life-threatening, but timing is everything.

I understand that when a patient goes to an outpatient drawing center, the tests don’t get done right away. The samples are batched, sent to a central lab, and the tests can be done 12 to 18 hours later. But that means that the 5 am phone call about a blood sugar of 40 is about a specimen that was drawn at 8 am the day before. So presumably, the patient has eaten by the time the poor physician is awakened from his blissful sleep. Either that or he’s dead, and either way, it can wait until office hours.

And then there are those chronically abnormal “critical” labs. I have a nephrologist colleague who keeps getting calls about creatinine levels that are high, but those patients always have high creatinines-because they are dialysis patients. He has an odd sense of humor, so he has taken to screaming in faux panic, “Oh no! Oh no! What are we going to do!” and hanging up on the lab employee.

When I was still in fellowship training, I would actually call the patients to make sure they were okay. They were not pleased about being woken up at 5 am either. I have since learned my lesson. Now when the lab employee asks me if I want the patient’s phone number, I politely (sometimes) decline. Sometimes, not so politely.

I understand the premise behind the calls, but there has to be a way to insert some common sense here. Certainly abnormal STAT labs require notification. If the diagnosis code is for end-stage renal disease, maybe it is not necessary to alert the office. Any specimen that is drawn more than 18 hours prior can wait ‘til office hours, or at least decent waking hours. OK, maybe that can’t be generalized, but perhaps put in place for certain tests.

Don’t misunderstand me. Yes, physicians need to be informed of results that are truly critical and need to be addressed right away. And if a patient’s life is at stake, we should be awakened. But there are data that show sleep-deprived physicians have poorer decision-making skills than their more rested counterparts, so if we can avoid unnecessary interruptions it would be beneficial for all-including the poor lab people who get yelled at even though it’s not their fault.

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