Detecting Preanalytical Errors Using Quality Indicators in a Hematology Laboratory

Abstract

Background and Objectives: Monitoring laboratory performance continuously is crucial for recognizing errors and fostering further improvements in laboratory medicine. This study aimed to review the quality indicators (QIs) and describe the laboratory errors in the preanalytical phase of hematology testing in a clinical laboratory. Methods: All samples received in the Hematology Laboratory of the Maternity and Pediatric Hospital in Hail for 3 years were retrospectively reviewed and evaluated for preanalytical issues using a set of QIs. The rate of each QI was compared to the quality specifications cited in the literature. Results: A total of 95002 blood samples were collected for analysis in the hematology laboratory from January 2017 through December 2019. Overall, 8852 (9.3%) were considered to show preanalytical errors. The most common were “clotted specimen” (3.6%) and “samples not received” (3.5%). Based on the quality specifications, the preanalytical QIs were classified generally as low and medium level of performance. In contrast, the sigma-based performance level indicates acceptable performance on all the key processes. Further analysis of the study showed a decreasing rate of preanalytical errors from 11.6% to 6.5%. Conclusions: Preanalytical errors remain a challenge to hematology laboratories. The errors in this case were predominantly related to specimen collection procedures that compromised the specimen quality. Quality indicators are a valuable instrument in the preanalytical phase that allows an opportunity to improve and explore clinical laboratory process performance and progress. Continual monitoring and management of QI data are critical to ensure ongoing satisfactory performance and to enhance the quality in the preanalytical phase.

Pre-analytical Quality Assurance; An Important Milestone to be Achieved

“…21 Studies have been conducted that showed 2-4 times reduction in pre analytical errors when the staff was properly trained. 11,19,20 In the assessment of knowledge for microbiological investigations it was found that both doctors and nurses did not have good knowledge about the time of collection and nature of the specimen required. Higher mean value was observed in the awareness of doctors as compared to nurses.…”

Preanalytical Errors in Clinical Laboratory Testing at a Glance: Source and Control Measures

“…Over the years, more sources of preanalytical error have been studied, and various measures (Figure 3) have been taken to minimize the error. *Harmonization [10]; *Education and training [30,31]; *Hemolytic, icteric, lipemic [4,5,32]; *Quality monitoring [33][34][35]; *Automation [34,36,37] Image Credit: Susmita Sinha…”

“…Realizing the importance of preanalytical error, many laboratories incorporate the performance of the preanalytical phase as their quality indicator (QI). Studies have proven that this exercise has significantly reduced laboratory error [34,35]. There have been efforts by the International Federation of Clinical Chemistry (IFCC) working group on laboratory errors and patient safety (WG-LEPS) to standardize the implementation of preanalytical error monitoring by developing a model of QI (MQI) [32].…”

Indicadores de calidad para evaluar los errores en las fases del laboratorio clínico.

“…Indicadores preanalíticos: tipo de muestra incorrecto, contenedor de muestra incorrecto, nivel de llenado incorrecto, muestra coagulada, muestra hemolizada, muestra no recibida Alshaghdali et al, (2022Alshaghdali et al, ( ) 2022 Laboratorio de Hematología del Hospital de Maternidad y Pediatría de Hail, Arabia Saudita / 3 años.…”