Background: Critical values are life-threatening laboratory results requiring immediate clinical intervention. While high-income countries have heavily automated the notification process via Laboratory Information Systems (LIS) and middleware algorithms, low- and middle-income countries (LMICs) often rely on manual, error-prone workflows.

Objective: To review current practices, challenges, and strategies for critical value notification; to compare proprietary versus open-source LIS notification systems for LMIC settings; and to propose a standardized closed-loop algorithm to improve patient safety.

Methods: A narrative review of current guidelines (CLSI, CAP, Joint Commission and ISO 15189:2022), LIS technologies, and implementation barriers was conducted. We specifically examine the challenges of power instability, software costs, and personnel shortages in Africa.

Results: Automation reduces notification time from an average of >40 minutes (manual) to <6 minutes (fully automated LIS). However, successful implementation requires overcoming significant infrastructural barriers. Case studies from Nigeria and Kenya demonstrate the viability of hybrid models, such as SMS-based automated alerts and open-source LIS, to bridge this gap.

Conclusion: Closed-loop communication for critical values is essential for patient safety. Achieving it requires investment in locally adaptable technologies, structured governance, and continuous personnel training, particularly in resource-limited settings.

Keywords: Critical Values; Laboratory Information System; Patient Safety; SMS Alert; Open-source LIS; Notification Algorithm; LMIC.