{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T16:02:25Z","timestamp":1789488145488,"version":"build-2803163510"},"reference-count":40,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T00:00:00Z","timestamp":1777507200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T00:00:00Z","timestamp":1777507200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["ascpt.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clin Pharma and Therapeutics"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:p>\n                    Critical limits represent quantitative decision thresholds for drugs that require immediate clinician notification and potential life\u2010saving intervention. United States hospitals lack a national standard for drug critical limits. We collected critical limits from 417 US hospitals across all 50 states and Washington, D.C.; of these, 411 maintained drug critical limit lists. We classified hospitals by US Census division and network\u2010affiliated vs. independent status. We applied non\u2010parametric statistical analyses, examined critical limits for 111 drugs, and observed significant inter\u2010institutional variability. Listing frequencies were highest for digoxin 99.8% (410\/411), theophylline 72.3% (297\/411), lithium 94.9% (390\/411), and acetaminophen 86.9% (357\/411). Non\u2010therapeutic measurands also appeared, led by ethanol 47.2% (194\/411). Kruskal\u2013Wallis analysis revealed highly significant differences (\n                    <jats:italic>P<\/jats:italic>\n                    \u2009&lt;\u20090.01) across census divisions. Mann\u2013Whitney\n                    <jats:italic>U<\/jats:italic>\n                    analysis comparing network vs. independent hospitals yielded significant differences (\n                    <jats:italic>P<\/jats:italic>\n                    \u2009&lt;\u20090.05) in 16 analytes. Qualitative critical values were listed for volatile alcohols and methotrexate. All digoxin critical limits exceeded levels associated with increased hazard ratios. Only 33.9% of hospitals aligned with consensus guidelines for acetaminophen poisoning. Vancomycin and aminoglycoside critical limits showed wide ranges, overlapping peaks and troughs, and random values inconsistently aligned with peak and troughs. Immunosuppressant critical limits often exceeded thresholds associated with toxicity. Psychotropic drugs, including antiepileptics, tricyclic antidepressants, and lithium, demonstrated variability and misalignment relative to consensus guidelines. Drugs of abuse did not appear in critical notification lists. Results provide hospitals with references that will enhance hospital notification practices and patient safety. We encourage sharing of critical notification lists to foster future research efforts and enhance standards of care.\n                  <\/jats:p>","DOI":"10.1002\/cpt.70277","type":"journal-article","created":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T03:30:09Z","timestamp":1777606209000},"page":"178-192","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Drug Critical Limits for Urgent Physician Notification"],"prefix":"10.1002","volume":"120","author":[{"given":"Elina","family":"Kuang","sequence":"first","affiliation":[{"name":"Department of Neurobiology, Physiology, and Behavior University of California, Davis  Davis California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasmeen","family":"Ibrahim","sequence":"additional","affiliation":[{"name":"Department of Human Biology University of California, Davis  Davis California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyle","family":"Cheng","sequence":"additional","affiliation":[{"name":"Department of Biotechnology Brown University  Providence Rhode Island USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerald J.","family":"Kost","sequence":"additional","affiliation":[{"name":"Emeritus Faculty in the Department of Pathology and Laboratory Medicine, POCT\u00b7CTR, School of Medicine University of California  Davis California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,4,30]]},"reference":[{"key":"e_1_2_13_1_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1990.03440050103044"},{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1990.03440050098042"},{"key":"e_1_2_13_3_1","unstructured":"The Joint Commission.National Patient Safety Goals\u00ae effective January 2026 for the Laboratory Program<https:\/\/digitalassets.jointcommission.org> (2026). 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