B-103 Implementation of an Automated Critical Value Module in a Latin American Oncology Institute Laboratory: Process Optimization and Clinical Impact Analysis

Abstract

Background In high-complexity oncology, rapid communication of laboratory critical values (CV) is essential to ensure patient safety and enable timely therapeutic interventions. Prior to implementation, the laboratory at Instituto Alexander Fleming (IAF), located in Argentina and recognized as the first private oncology center in Latin America, relied on manual identification of critical values (CV) using Excel spreadsheets. This process was prone to errors, lacked traceability, and caused delays. This study aims to assess the impact of implementing an automated CV alert module within the Laboratory Information System (LIS) on reporting efficiency and downstream clinical intervention. Methods A dual-phase study was conducted. First, a quasi-experimental pre-post implementation analysis compared a manual recording period (Nov 2022–Apr 2023) with an automated period (Nov 2023–Apr 2024). Variables included the number of communicated CV and reporting time, defined as detection-to-notification. Statistical analysis was performed to compare pre- and post-implementation periods. Laboratory analyzers (Abbott Diagnostics) were interfaced with the LIS (Kern LIS, Argentina), enabling automated alerts to be triggered when a critical value result was transmitted from the analyzer to the LIS. Second, a retrospective observational study (Nov 2023–Apr 2024) assessed clinical impact in emergency department patients and outpatients for the three most frequently reported CV analytes: Hemoglobin (HGB), white blood cells (WBC), and potassium (K). Medical response times (notification-to-action), types of clinical interventions, and hospitalization rates were evaluated. Results The implementation of the automated critical value module significantly increased the number of communicated CVs from 336 to 881 (p < 0.0001). The median reporting time was reduced from 26 to 10 minutes (p < 0.0001). Regarding clinical impact, 94.1% of outpatients and 98.8% of emergency department patients received documented medical intervention following CV notification. Specific therapeutic actions were more frequent in the emergency department (94.2%) compared with outpatients (76.5%). Emergency department settings showed faster clinical response times (median 64 minutes) and higher hospitalization rates (75.6%) compared with the outpatient setting, which had a median response time of 88 minutes and a hospitalization rate of 22.4%. Conclusion The implementation of the automated module optimized CV management by drastically reducing reporting times and enhancing data traceability. Beyond technical efficiency, the system proved to be a vital clinical support tool, ensuring high rates of timely medical interventions in more than 94% of cases. In the context of high-complexity oncologic care, where patients are particularly vulnerable to rapid clinical deterioration, these findings confirm that automation effectively supports timely, and potentially life-saving, clinical decision-making.