Error tracking in a clinical biochemistry laboratory

Szecsi, Pal B.; Ødum, Lars

doi:10.1515/cclm.2009.272

Cited by 52 publications

(31 citation statements)

References 17 publications

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“…There has been varied information on error rate within whole lab testing procedure (0.1-9.3%). 7 Our study is in accordance with Pleboni and Carroro who in their research also observed that majority of errors in laboratory results due to the problem in pre-analytical phase.…”

Section: Discussionsupporting

confidence: 92%

Evaluation of Types of Pre-Analytical Errors in Clinical Chemistry Laboratory

Barapatre¹,

Jadhao²,

Lokhande³

2016

jemds

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OBJECTIVEEvaluation of leading causes of pre-analytical errors in Clinical Biochemistry Laboratory. MATERIALS AND METHODSSamples were obtained from the OPD and indoor admitted patients and analysis of the results obtained from clinical chemistry laboratory obtained during one year of study period was done retrospectively. Data was summarised regarding the frequency of factors affecting the pre-analytical quality of results. Laboratory personnel were asked to register all the rejected samples and reasons for rejections. RESULTSOut of 62541 inpatient samples collected and screened over period, pre-analytical errors were observed in 4611 samples, which is approximately 3.75% of the total blood samples received. Insufficient volume of samples accounted for rejection of 2428 samples, which is 1.9% of total samples received during this period. Haemolysis accounted for rejection of 1.1% of samples and gross lipaemia was responsible for rejection of 0.4% samples. 0.26% of samples were rejected for having wrong/incomplete patient information. Out of 60244 samples collected total from OPD, 5552 samples were rejected for the presence of pre-analytical errors. This accounted for rejection of 4.5% of total samples received during this period. 2.7% of samples were rejected for the presence of visible haemolysis after centrifugation. Samples rejected for insufficient volume accounted to 1.9%. 0.3% of samples were rejected for having gross lipaemia. 800 samples were rejected for having wrong/incomplete patient information, which accounted for rejection of 0.8%. CONCLUSIONThe overall rate of rejection of samples is 8.52%, which is very high. Haemolysis was major reason for rejection of samples collected from OPD and error due to insufficient sample volume was found to be equal in both type of samples collected from OPD and indoor patients. KEYWORDSPre-analytical Errors, Hemolysis, Lipemia. The main aim for the diagnostic service is to get correct result on correct patient to the requesting doctor without unnecessary delays. It is also the duty of laboratory to protect patients from wrong or potentially wrong results. Typical request test report cycle consists of three phases, pre-analytical, analytical, and post-analytical phases. HOW TO CITE THIS ARTICLE:Errors arising during the sample processing are classified into pre-analytical, analytical, and post-analytical errors depending upon their source and time of presentation respectively. 1 Overall, the three processes combined are Financial or Other, Competing Interest: None. Submission 20-06-2016, Peer Review 04-08-2016, Acceptance 11-08-2016, Published 17-08-2016. Corresponding Author: Dr. Amit Ramesh Barapatre, Room No. 415, Department of Biochemistry, Fourth Floor, College Building, TNMC NAIR and B.Y.L. Ch. Hospital, Mumbai Central-08. E-mail: amit12patre@gmail.com DOI: 10.14260/jemds/2016/1076 called as 'total testing processes.' Errors can arise at any step and lead to a faulty report generation that can affect patient care like misdiagnosis, improper t...

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Section: Discussionsupporting

confidence: 92%

Evaluation of Types of Pre-Analytical Errors in Clinical Chemistry Laboratory

Barapatre¹,

Jadhao²,

Lokhande³

2016

jemds

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“…Although several articles have described preanalytic errors in terms of unacceptable samples, such as hemolysed, clotted, and/or insufficient specimens (4,5,(7)(8)(9), few data available in the literature relate this type of quality failure to mechanisms and procedures which, if not followed, expose patients to the risk of errors and the related adverse events, particularly in the case of patient misidentification. The data reported in the present study confirm the relative frequency of prepreanalytic errors, including the misidentification error rates, found to be 359 parts per million (ppm), a rate that is similar to that previously reported (270 ppm) (5 ).…”

Section: Discussionmentioning

confidence: 99%

Exploring the Initial Steps of the Testing Process: Frequency and Nature of Pre-Preanalytic Errors

Zago²,

2012

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BACKGROUND Few data are available on the nature of errors in the so-called pre-preanalytic phase, the initial steps of the testing process. We therefore sought to evaluate pre-preanalytic errors using a study design that enabled us to observe the initial procedures performed in the ward, from the physician's test request to the delivery of specimens in the clinical laboratory. METHODS After a 1-week direct observational phase designed to identify the operating procedures followed in 3 clinical wards, we recorded all nonconformities and errors occurring over a 6-month period. Overall, the study considered 8547 test requests, for which 15 917 blood sample tubes were collected and 52 982 tests undertaken. RESULTS No significant differences in error rates were found between the observational phase and the overall study period, but underfilling of coagulation tubes was found to occur more frequently in the direct observational phase (P = 0.043). In the overall study period, the frequency of errors was found to be particularly high regarding order transmission [29 916 parts per million (ppm)] and hemolysed samples (2537 ppm). The frequency of patient misidentification was 352 ppm, and the most frequent nonconformities were test requests recorded in the diary without the patient's name and failure to check the patient's identity at the time of blood draw. CONCLUSION The data collected in our study confirm the relative frequency of pre-preanalytic errors and underline the need to consensually prepare and adopt effective standard operating procedures in the initial steps of laboratory testing and to monitor compliance with these procedures over time.

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“…The number of pre-analytical factors of variation is very high as published and itemized by Young (2007). According to estimations in human laboratory diagnostics, the lack of standardized procedures in specimen acquisition, handling and storage account for the majority of all errors currently encountered within the entire diagnostic process (Lippi et al, 2006a;Wallin et al, 2008;Szecsi and Odum, 2009;Goswami et al, 2010).…”

Section: Introductionmentioning

confidence: 99%

Pre-analytical factors affecting the results of laboratory blood analyses in farm animal veterinary diagnostics

Humann-Ziehank

Ganter

2012

Animal

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The quality of the laboratory diagnostic approach in farm animals can be severely affected by pre-analytical factors of variation. They induce increase/decrease of biochemical and hematological analyte concentrations and, as a consequence, they may cause unsuitable conclusions and decisions for animal health management and research projects. The pre-analytical period covers the preparation of sampling, the sampling procedure itself, as well as all specimen handling until the beginning of the specific laboratory analysis. Pre-analytical factors may have either an animal-related or a technique-related background. Animal-related factors cover daytime/season, meals/fasting, age, gender, altitude, drugs/anesthesia, physical exercise/stress or coinfection. Technique-related factors are the choice of the tube including serum v. plasma, effects of anticoagulants/gel separators, the anticoagulant/blood ratio, the blood collection procedure itself, specimen handling, contamination, labeling, storage and serum/plasma separation, transportation of the specimen, as well as sample preparation before analysis in the laboratory. It is essential to have proper knowledge about the importance and source of pre-analytical factors to alter the entire diagnostic process. Utmost efforts should be made to minimize controllable factors. Analytical results have to be evaluated with care considering that pre-analytical factors of variation are possible causes of misinterpretation.

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Error tracking in a clinical biochemistry laboratory

Cited by 52 publications

References 17 publications

Evaluation of Types of Pre-Analytical Errors in Clinical Chemistry Laboratory

Evaluation of Types of Pre-Analytical Errors in Clinical Chemistry Laboratory

Exploring the Initial Steps of the Testing Process: Frequency and Nature of Pre-Preanalytic Errors

Pre-analytical factors affecting the results of laboratory blood analyses in farm animal veterinary diagnostics

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