Using the App

Communication of 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)
• Simulates the clinician phone-call end-to-end with realistic responses
• Tests the read-back protocol — does the receiver repeat the value, units, and patient identifier?
• Drills the escalation pathway when you cannot reach the named clinician
• Captures your documentation for the audit trail

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 lets you upload your Trust's list for accurate practice.

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

Completed sessions are IBMS Specialist Portfolio evidence in your home specialty's post-analytical phase.

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"