Quality Indicators for Evaluating Errors in the Preanalytical Phase

Abstract

Objective The aim of this study was to study the incidence of preanalytical errors in the clinical chemistry laboratory attached to a tertiary care hospital. Design and Methods The study was conducted in a clinical chemistry laboratory using the samples and forms received for analysis. Five hundred random samples were analyzed using a predefined set of quality indicators (QIs) over a period of 3 months. The incidence of each preanalytical error was described as a percentage of the total samples analyzed in the study. Statistical Analysis Individual QIs were assigned values as 0 and 1 and were used to assess each sample; 0 if the error was present, and 1 if absent. The incidence of each preanalytical error was described as a percentage of the total samples analyzed in the study. Result Out of the 500 samples observed, 138 samples were error free, while 21 samples had the maximum number of errors, that is, 6. The error committed most often was the omission of provisional diagnosis being mentioned on the requisition form. No preanalytical error was observed for QIs: selecting the appropriate blood collection vial or storage of sample. Conclusion This study confirms that error rate in the preanalytical phase is high and vastly ignored. Errors committed here may be overlooked, given the large number of samples received in the clinical laboratory of a tertiary center. To reduce these errors, the laboratory should provide training to all workers involved in the preanalytical phase. Daily or weekly QI scores should be recorded to assess and rectify shortcomings, thereby improving patient care.

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…”

“…Various training methods, including direct education, e-learning, or providing reports on sample quality, can be used. One study demonstrated that a role-play model for training interns on the importance of the preanalytical phase has shown positive outcomes as it simulates actual situations [1,34]. It is essential that training is continuous to ensure the continuity of transfer of skills and knowledge.…”

“…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].…”

“…Replacing manual activities with automation has significantly reduced laboratory error, particularly in the analytical and post-analytical phases [34]. The development of Laboratory Information Software (LIS) played a significant role in laboratory automation and has replaced some of the manual processing in the preanalytical phase.…”