Using the App

Critical Values Simulator

Premium tool. Open from /training-dashboard → Critical Values card (the dashboard uses this short label), or directly at /critical-values.

Critical-value telephone communication is one of the highest-risk routine activities in pathology. This simulator drills the protocol from the moment the analyser flags a result.

What it does

• Generates a critical-result scenario (e.g. potassium 7.8, troponin 850, Hb 55 g/L, calcium 1.5)
• Runs a typed SBAR communication simulator (Situation, Background, Assessment, Recommendation) in which you communicate the result to a simulated clinician and get feedback on structure and content
• Teaches the read-back protocol — value, units and patient identifier repeated back
• Drills the escalation pathway when you cannot reach the named clinician
• Explains the documentation needed for the audit trail

There is no voice or phone-call mode; the exchange is typed. For a Band 2 to 3 version focused on support staff, see the separate Communication of Critical Values trainer.

Read-back protocol (current UK practice)

1. State your name and lab — "This is the Biochemistry lab"
2. Identify the patient — full name, date of birth, NHS / hospital number
3. State the result clearly — "Potassium seven point eight millimoles per litre" (spell out, no shorthand)
4. Ask for read-back — "Can you read that back to me?"
5. Confirm read-back is correct — explicit "yes/no" exchange
6. Document — time of call, who you spoke to, what was said, your name

If you cannot get a clear read-back you have not communicated the result. Try again or escalate.

Critical-value lists

The simulator covers UK-standard critical lists for:

• Biochemistry — K, Na, glucose, calcium, troponin, lactate, ammonia
• Haematology — Hb, platelets, WBC, neutrophils, blasts on film
• Coagulation — INR (warfarin), APTT, fibrinogen
• Microbiology — sentinel organisms (CPE, Neisseria meningitidis, Mycobacterium tuberculosis), positive blood culture
• Virology — newly diagnosed HIV, hepatitis seroconversion
• Andrology / Reproductive — azoospermia in samples for cryopreservation

Local lists vary. The simulator cannot load your Trust's own list, so keep it beside you and check the thresholds it uses against yours.

Escalation pathways

When the named clinician cannot be reached:

1. Try the bleep
2. Try the ward / team office
3. Try the on-call for that specialty
4. Try the patient safety / medical on-call
5. Escalate to your own lab consultant or section head

Document each attempt with time. Persistence of failure to communicate is itself a reportable incident.

Standards alignment

• The Joint Commission read-back protocol (international gold-standard)
• Royal College of Pathologists critical-value guidance
• RCPath Best Practice Guidance for laboratory test reporting
• ISO 15189:2022 clause 7.4 (post-examination)
• Your Trust's local SOP

Bands and competency mapping

• Band 5 — execute the protocol independently
• Band 6 / 7 — lead reviews of failed-to-communicate incidents, refine the critical list

Cite completed sessions in your IBMS Specialist Portfolio evidence for the post-analytical phase of your specialty.

Common interview question themes

• "Walk me through your critical-value telephone protocol"
• "What do you do when you can't reach the named clinician?"
• "How do you handle a clinician who refuses to take the result?"
• "How is your critical-value list maintained and updated?"
• "Tell me about a critical value that became a clinical incident"