OBJECTIVES: Follow-up of critical laboratory results can present a challenge in resource limited settings due to high patient volumes, overstretched human resources and no systematic communication from the laboratory. An audit conducted in 2013 in a large outpatient HIV-center revealed that <50% of critical results were acted upon within 24 hours. Our objective is to describe the impact of the new developed guidelines on reducing mortality of patients with critical results. METHODS: Results must be immediately communicated by the laboratory to a physician via an “on-call phone”; patients should be contacted and asked to return to the clinic. In addition all critical laboratory results were reviewed and tagged by Quality Management staff. Design: retrospective survey of all files of patients who had in 2014 at least one of the following: Hb <5.5g/dl, creatinine >3.4mg/dl, positive serum Cryptococcus-Antigen (Crag). Clinician’s actions were categorized and described. Turnaround time was determined and incidence of mortality between 2013 and 2014 compared. RESULTS: During 2014, 5,907 patients had any laboratory test done. Hb <5.5g/dl: 36(0.6%) patients. Action taken: blood transfusion 17/36 (47%), heamatinics14/36(39%) and 2/36(6%) dewormed. Creatinine >3.4mg/dl: 64/3291(1.9%) patients. Action taken: antiretroviral treatment regimen switched 43/64(67%), 2/64(3%) stopped, 12/64(19%) referral to the renal unit. Positive serum-Crag 17/464(3.7%). Action taken: 12/17(71%) started on fluconazole, 5/17(29%) were already on treatment. Turnaround time for Hb and serum crag was <1 day, creatinine 13.3 days. From 2013 and 2014 the mortality decreased in patients with Hb<5.5g/dl from 27.9 to 2.8%, with creatinine>3.4mg/dl from 32.9 to 3.1% and with positive serum-Crag from 36.4 to 23.5%. CONCLUSIONS: Critical results monitoring system greatly improves patient turnaround time, and reduces mortality through timely communication and patients follow up. We believe our system could serve as a role model for similar programs in Sub-Saharan Africa to improve quality of care.