Critical Value Identified
Result meets critical threshold
All Pathways
PathologyManagement
Critical Values Reporting Protocol (CAP)
Critical Values Reporting Protocol (CAP): Critical Value Identified → Verify Result → Type of Critical Value → Chemistry Critical Values → Notification ...
Pathway Overview
10 steps
Algorithm Steps
10 total
01Start 02Action Verify Result
Confirm accuracy before notification
- Check specimen integrity
- Review for pre-analytical errors
- Consider repeat if questionable
- Compare to prior values if available
- Ensure correct patient ID
03Decision Type of Critical Value
Chemistry, Hematology, Anatomic Path
04Action Chemistry Critical Values
Common thresholds (institution-specific)
- Glucose: <40 or >500 mg/dL
- Potassium: <2.5 or >6.5 mEq/L
- Sodium: <120 or >160 mEq/L
- Calcium: <6.5 or >13.0 mg/dL
- Troponin: Initial positive
- Lactate: >4 mmol/L
05Action Notification Process
Contact responsible provider
- Direct verbal communication required
- Contact ordering provider or covering MD
- Escalation if unable to reach in 30-60 min
- Do not leave voicemail as sole notification
- After-hours: on-call provider or nursing
06Action Documentation
Required elements
- Date and time of call
- Name of person notified
- Read-back of result
- Caller identification
- Time from result to notification
- Document in LIS and patient chart
07Outcome Critical Value Reported
Notification complete and documented
08Warning Escalation
If unable to notify
- Supervisor notification
- Alternative provider contacted
- Hospital operator/page operator
- Document all attempts
- Follow institutional policy
- Path rejoins step 06Shared downstream outcome
09Action Hematology Critical Values
Common thresholds
- Hemoglobin: <7 or >20 g/dL
- Platelets: <20,000 or >1,000,000/μL
- WBC: <2,000 or >100,000/μL
- PT/INR: >5.0
- PTT: >100 sec (on heparin)
- Fibrinogen: <100 mg/dL
- Path rejoins step 05Shared downstream outcome
10Action Anatomic Path Critical Values
Findings requiring urgent notification
- Unexpected malignancy
- Leukemia/lymphoma on frozen
- Organisms in CSF/blood/tissue
- Positive acid-fast smear
- Acute rejection (transplant)
- Unexpected diagnosis affecting surgery
- Path rejoins step 05Shared downstream outcome
Guideline Source
CAP Laboratory Critical Values Guidelines
Clinical Safety Information
Clinical Decision Support — Not a Substitute for Clinical Judgment
Individual patient factors may require deviation from these recommendations.
Known Limitations
- Critical values vary by institution
- Does not include all possible critical results
- Notification time requirements vary
- Read-back documentation essential
- Escalation procedures differ by lab
Applicable Regions
USAUUKEU
AU: NPAAC notification requirements
UK: CQC laboratory standards
US: CAP and TJC requirements
Version 1Next review: 2027-01-01
Next steps
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Related Resources
Frequently Asked Questions
What is the Critical Values Reporting Protocol (CAP)?
The Critical Values Reporting Protocol (CAP) is a management clinical algorithm for Pathology. It provides a structured decision tree to guide clinical decision-making, based on CAP Laboratory Critical Values Guidelines.
What guideline is the Critical Values Reporting Protocol (CAP) based on?
This algorithm is based on CAP Laboratory Critical Values Guidelines (DOI: 10.5858/arpa.2021-0074-CP).
What are the limitations of the Critical Values Reporting Protocol (CAP)?
Known limitations include: Critical values vary by institution; Does not include all possible critical results; Notification time requirements vary; Read-back documentation essential; Escalation procedures differ by lab. Individual patient factors may require deviation from these recommendations.
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