IntroductionThe presence of errors in the preanalytical phase is a thoroughly studied problem. A strategy to increase their source detection might be the use of the Healthcare Failure Mode and Effects Analysis (HFMEA). The aim of this study is improving the capacity of identifying sources of error during the preanalytical period in samples provided by primary care clinics (PCC) with the use of the HFMEA as a tool in the laboratories of two tertiary hospitals.Materials and methodsA HFMEA was carried out in each laboratory, by means of the creation of groups of experts with similar characteristics (doctors and nurses from PCC and laboratory, support staff, and laboratory technicians). The Risk Priority Number (RPN) was calculated.ResultsItems with elevated RPN were presented in both centers. The highest RPN were in LAB1: “two request notes for a patient” and “the segregation of oncology urgent samples” (both with 384), while in LAB2 was “the lack of information in patients with oral glucose overload test” (RPN 576). Considering the different steps in the preanalytical phase, LAB1 paid attention in sampling, samples reception and the programming in the Laboratory Information System, while LAB2 paid attention in the request form, the appointment system, sampling procedures, transport and reception.ConclusionThe laboratories prioritized the problems differently. However, both centers offer solutions to these possible sources of error. We proposed improvement actions that can be resolved easily, with a low cost for the system, mainly to schedule a specific formative programme and a deep revision of the existing protocols.

Background: To perform a cost-error analysis based on a quasi-experimental pre-post study of the preanalytical errors in 2 hospital laboratories. The real cost and theoretical cost are defined as the cost resulting from errors with or without the training intervention. The real impact associated to the training program was estimated, calculated as the total associated to the preanalytical errors cost difference. The costs were measured using Andalusian Public Health Service fees. Cost analysis of an educational intervention presented in a previous study from 2017. Preanalytical errors were detected in the laboratories of the University Hospital Virgen de la Victoria (Málaga, Spain) and in the University Hospital Juan Ramón Jiménez (Huelva, Spain). Methods: The founded errors were divided into blood and urine samples. Univariate sensitivity analysis was used to assess how parameter uncertainty impacted on overall results. Variations of parameters between 0% and 5% were substituted into the base case. Results: The real impact associated with educational intervention in LAB1 was an increase of €16,961.378, and the expected impact was an increase €78,745.27 (difference of €61,783.9). In LAB2, the real impact in the same period amounted to €260,195.37, and the expected impact was €193,905.83 (difference of −€66,289.54). The results were different in the 2 laboratories, proving the intervention in only one of them to be more effective. Conclusions: Costs analysis determined that this training intervention can provide saves in the costs, as the effectiveness of the educational sessions in reducing preanalytical errors currently results in a significant decrease of the costs associated with these errors.

Background: The presence of preanalytical errors is arecurring fact in all areas of healthcare that send samples to laboratories. Increasing the knowledge of possible sources of error in the preanalytical phase has been the objective of this group during the last 10 years.Methods: In this study, descriptive research has been carried out using professionals’ opinions obtained by means of the Strengths, Weaknesses, Opportunities, and Threats method in a focus group.Results: The opinions expressed within the focus group have emphasised the importance of patients’ safety andwillingness for the introduction of a computerized analytical module. The most commented weakness in both hospitals was the transport of samples through the pneumatic tube.Improving the duration of workers’ contracts, especially in the laboratory, and creating a circuit for professional’s localization during the work shift to facilitate potential error solving are some opportunities for the future. Conclusions: Different approaches have been developed depending on the healthcare scenario. For this, establishing a flow of information between the different professionals allows identifying identical aspects through a priori, different points of view. The line to follow is to improve the safety of the patient and also to give professionals an opportunity to express themselves.

No abstract

The clinical and economic relevance of the clinical laboratories procedures in Andalusia (Spain) have led the Regional Department of Health to focus attention on their improvement. A unified laboratory protocol was implemented that consisted of the unification of criteria in the handling and processing of samples, and report of results.The objective of this study is to describe the degree of compliance with the clinical laboratory protocol in the preanalytical phase, which includes the analytical request and up to the delivery in the laboratory, as well as the influencing factors.Cross-sectional descriptive study with a sample of 214 healthcare professionals involved in the preanalytical phase of laboratory procedures in primary care. A self-reported questionnaire with 11 items was used for data collection. Each item was assessed separately with a scale from 0 to 10. A 5 points score was considered as the cutoff point. Descriptive analysis was conducted and Mann-Whitney U test was used to determine differences between subgroups. Internal consistency of the questionnaire was considered.The best rated item was verifying the correspondence between the request form and identity of the patient. Each item scored from 3 to 10, and the mean for each item ranged from 6.40 (standard deviation = 3.06) to 8.57 (standard deviation = 2.00). Values above or equal to 8 were obtained, for 63.6% of them. Statistically significant differences between accredited and nonaccredited centres were found. Differences were not noteworthy regarding centres with a teaching activity or those without it. All the items were measured separately. The compliance with the protocol was adequate among primary healthcare professionals, who have a strategic position in the sample collection and its transport during the preanalytical phase. Being so, standardisation should be a priority to reduce errors and improve clinical safety and results. Abbreviations: ACSA = agencia de calidad sanitaria de Andalucía -Andalusian health quality agency, PAI = procesos asistenciales integrados -integrated care processes, PC = primary care, SD = standard deviation.