Hi, Our organization is assessing the critical call-back level of lactate to clinicians from the lab. Currently, our call-back level is 4 mmol/L which places an individual in septic shock within the sepsis continuum. In order to identify patients earlier, i.e., those who will require bundle implementation with severe sepsis (lactate >/= 2), we have requested the that critical value call-back level be changed to 2 mmol/L. However, there is debate surrounding this secondary to concerns on whether or not the sample is arterial or venous -- depending on the source of the sample, there are different ranges of normal. I haven't been able to find anything in the CMS Core Measure Specs Manual that addresses whether or not the sample is arterial or venous when identifying septic patients with elevated lactate levels as a marker for organ dysfunction.
A few questions: Specifically, are there any organizations that have a lactate of 2 mmol/L prompting a call from the lab for a critical value, and/or what is your critical call-back level for lactate? Does anyone have any specific literature and/or pointed direction that you are willing to share with regards to this topic? Any help would be appreciated here. Thanks so much in advance, Melissa Keck, RN, MSN/MSBA Sepsis Coordinator Quality Management Beaumont Hospital - Dearborn Oakwood Campus 18101 Oakwood Blvd. Dearborn, MI 48124 Office: 313.593.7103 Fax: 313.982.5671 Internal Page: #2513 External Page: 313-503-2068 x2513 [email protected]<mailto:[email protected]> [cid:[email protected]]
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