Incomplete laboratory request forms: the extent and impact on critical results at a tertiary hospital in South Africa

Abstract

Background: Research has demonstrated that most laboratory errors occur in the preanalytical phase of testing. In view of the paucity of studies examining preanalytical errors, we evaluated our laboratory request forms for the frequency and impact of incomplete data. Methods: This study examined all request forms received at our laboratory during a five-day period. The forms were scrutinized for the presence of specific parameters. The impact of abbreviated diagnoses was analysed, as well as how lack of ward or telephone details affects the communication of critical results to clinicians. Results: A total of 2550 request forms were analysed. Medication(s) used by the patient (89.6%) and doctor's contact number (61.2%) were the most incomplete parameters. No diagnosis was provided on 19.1% of forms, and when a diagnosis was present it was an abbreviated form in 37.3%. This resulted in 35.5% of diagnoses not being recorded by reception staff. Incomplete ward information was found on 4.9% of forms. In a separate search, the impact of 151 request forms (collected over a period of eight months), with incomplete ward location information and corresponding to critical results was assessed. Critical results were not communicated by telephone to clinicians in 19.9% of cases. Conclusion: As laboratory data influences 70% of medical diagnoses, incorrect or incomplete data provided to the laboratory could significantly impact the success and cost of overall treatment.

Effect of Pre-Analytical Errors on Quality of Laboratory Medicine at a Neuropsychiatry Institute in North India

“…A similar study done by Nutt et al [10] reported that the information regarding the details of treating physician was missing in 61.2% the details of diagnosis was not indicated in 19.1% whereas in 80.9% where the diagnosis was mentioned, 37.3% were in the abbreviated forms. In total of 151 Critical results encountered in their study 19.9% were not communicated to physicians.…”

Blood Component Use in a Sub-Saharan African Country: Results of a 4-Year Evaluation of Diagnoses Associated With Transfusion Orders in Namibia

“…First, the multiple imputation methods used here are open to misclassification errors which may have skewed the distribution of ages, sex, or diagnoses. Similarly, because of incomplete and nonstandardized reporting by prescribing clinicians (a chronic problem reported elsewhere in Africa [54]), the imputation model could not include diagnoses that were not captured during the retrospective data collection process. This may have resulted in a loss of fidelity on the diversity of diagnoses.…”

Determination of errors that compromise the quality of laboratory service in a tertiary hospital

“…7 Similar study done. 8 reported that the information regarding the details of treating physician was missing in 61.2% the details of diagnosis was not indicated in 19.1% whereas in 80.9% where the diagnosis was mentioned,37.3% were abbreviated forms. In total of 151 critical results encountered in their study 19.9% were not communicated to physicians.…”

“…74.3% (110) of the preanalytical errors were attributed to: request forms lacking address (40, 27.0%); test not done in biochemistry lab (24, 16.2%); specimen drawn in wrong tube (20, 13.5%); specimen without request forms (10, 6.8%); unlabeled specimen (8,5.4%); and inadequate/insufficient sample after centrifugation (8,5.4%). The remaining 25.7% (38) of the pre-analytical phase errors are associated to: no patient name or identification number (7, 4.7%); contaminated specimen bottle (6, 4.1%); mismatched information on request form and specimen container (5, 3.4%) this could be attributed as a result of manual registration as shown in Plate 1; no specimen received yet there is request form (5, 3.4%); specimen not paid for (5, 3.4%); leaking specimen/ broken container (3, 2.0%); wrong specimen (3, 2.0%); specimen clotted yet test requires unclotted specimen (2, 1.4%); test not well specified (1, 0.7%); and wrong test compared to the container type (1, 0.7%).…”