The preanalytical phase – Past, present and future

Cornes, Michael

doi:10.1177/0004563219867989

Cited by 8 publications

(9 citation statements)

References 21 publications

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“…Finally, the interpretation, clinical authorization and communication of results to the requesting clinician constitutes the post-analytical phase [ 5 ]. Amongst all three, the pre-analytical phase is regarded as the most error prone phase [ 3 , 4 , 7 ]. According to the literature, the analytical errors account for less than 10%, post analytical errors for 18.5 to 47%, whereas the pre-analytical phase accounts for up to 70% of the total laboratory diagnostic errors [ 1 , 3 , 4 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

“…Amongst all three, the pre-analytical phase is regarded as the most error prone phase [ 3 , 4 , 7 ]. According to the literature, the analytical errors account for less than 10%, post analytical errors for 18.5 to 47%, whereas the pre-analytical phase accounts for up to 70% of the total laboratory diagnostic errors [ 1 , 3 , 4 , 7 ]. Laboratory errors can occur in any step of these phases and can be defined as “any defect from ordering tests to reporting results and appropriately interpreting and reacting on these" [ 2 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

“…Laboratory errors can occur in any step of these phases and can be defined as “any defect from ordering tests to reporting results and appropriately interpreting and reacting on these" [ 2 , 6 ]. With the advent of technology, automation and improvement in quality assurance and control measures, literature reports a ten-fold reduction in analytical errors in last two decades but pre-analytical issues is still the area of challenge for the laboratory professionals [ 1 , 3 , 6 , 7 ]. Such errors may impact the patient care and outcome in-terms of delayed diagnosis, longer stays at hospital, greater demand on resources and higher cost [ 3 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

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Development of a virtual classroom for pre-analytical phase of laboratory medicine for undergraduate medical students using the Delphi technique

et al. 2022

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Background Amongst the pre-analytical, analytical, and post-analytical phase of laboratory testing, pre-analytical phase is the most error-prone. Knowledge gaps in understanding of pre-analytical factors are identified in the clinical years amongst undergraduate students due to lack of formal teaching modules on the pre-analytical phase. This study was conducted to seek experts’ consensus in Clinical Chemistry on learning objectives and contents using the Delphi technique with an aim to develop an asynchronous virtual classroom for teaching pre-analytical factors of laboratory testing. Methods A mixed method study was conducted at the Aga Khan University. A questionnaire comprising of 16 learning objectives and their associated triggers was developed on Google Docs for developing the case vignettes. A four-point Likert Scale, which included strongly agree, agree, disagree and strongly disagree, was utilized for the learning objectives. An open-ended question was included for experts to suggest new items for inclusion. A cut off of at least 75% agreement was set to establish consensus on each item. A total of 17 Chemical Pathology faculty from 13 institutions across Pakistan were invited to participate in the first round of Delphi. Similar method of response was used in round two to establish consensus on the newly identified items suggested by the faculty in round 1. Later, the agreed-upon objectives and triggers were used to develop interactive scenarios over Moodle to concurrently test and teach medical students in a nonchalant manner. Results A total of 17 responses were received in Round 1 of the Delphi process (response rate = 100%), while 12 responses were received in Round 2 (response rate = 71%). In round 1, all 16 learning objectives reached the required consensus (≥ 75%) with no additional learning objectives suggested by the experts. Out of 75 triggers in round 1, 61 (81.3%) reached the consensus to be included while 39 were additionally suggested. In 2nd round, 17 out of 39 newly suggested triggers met the desired consensus. 14 triggers did not reach the consensus after two rounds, and were therefore eliminated. The virtual classroom developed using the agreed-upon learning objectives and triggers consisted of 20 items with a total score of 31 marks. The questions included multiple choice questions, fill in the blanks, drag and drop sequences and read-and-answer comprehensions. Specific learning points were included after each item and graphs and pictures were included for a vibrant experience. Conclusion We developed an effective and interactive virtual session with expert consensus on the pre-analytical phase of laboratory testing for undergraduate medical students which can be used for medical technologist, graduate students and fellows in Chemical Pathology.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Development of a virtual classroom for pre-analytical phase of laboratory medicine for undergraduate medical students using the Delphi technique

et al. 2022

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“…The clinical laboratories across the globe have adapted to maintain the highest standards of patient care despite the COVID-19 pandemic. The imprecision and inaccuracies in results occurring due to preanalytical errors have always been a major cause of concern for diagnostic laboratories ( 1 - 4 ). Preanalytical errors range between 46‐68% out of all errors occurring in the total testing process ( 5 ).…”

Section: Introductionmentioning

confidence: 99%

The rise in preanalytical errors during COVID-19 pandemic

Mukhopadhyay

Subramanian

Pandey

et al. 2021

Biochem. med. (Online)

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Introduction The COVID-19 pandemic has posed several challenges to clinical laboratories across the globe. Amidst the outbreak, errors occurring in the preanalytical phase of sample collection, transport and processing, can further lead to undesirable clinical consequences. Thus, this study was designed with the following objectives: (i) to determine and compare the blood specimen rejection rate of a clinical laboratory and (ii) to characterise and compare the types of preanalytical errors between the pre-pandemic and the pandemic phases. Materials and methods This retrospective study was carried out in a trauma-care hospital, presently converted to COVID-19 care centre. Data was collected from (i) pre-pandemic phase: 1 st October 2019 to 23 rd March 2020 and (ii) pandemic phase: 24 th March to 31 st October 2020. Blood specimen rejection rate was calculated as the proportion of blood collection tubes with preanalytical errors out of the total number received, expressed as percentage. Results Total of 107,716 blood specimens were screened of which 43,396 (40.3%) were received during the pandemic. The blood specimen rejection rate during the pandemic was significantly higher than the pre-pandemic phase (3.0% versus 1.1%; P < 0.001). Clotted samples were the commonest source of preanalytical errors in both phases. There was a significant increase in the improperly labelled samples (P < 0.001) and samples with insufficient volume (P < 0.001), whereas, a significant decline in samples with inadequate sample-anticoagulant ratio and haemolysed samples (P < 0.001). Conclusion In the ongoing pandemic, preanalytical errors and resultant blood specimen rejection rate in the clinical laboratory have significantly increased due to changed logistics. The study highlights the need for corrective steps at various levels to reduce preanalytical errors in order to optimise patient care and resource utilisation.

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“…Over the past decade, laboratories have gained an increasing understanding of the importance of error in the preanalytical phase (1,2). There is a clear need to identify, monitor, and reduce preanalytical errors (PAEs), which account for the majority of all errors in the total testing process (TTP) (3)(4)(5).…”

Section: Introductionmentioning

confidence: 99%

Case report of spuriously low sodium and calcium in a 36-year-old male in primary care

Costelloe

McCarthy

O'Connell

et al. 2020

Biochem. med. (Online)

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An unseparated serum specimen for a 36-year-old male was received from primary care. The specimen arrived in the laboratory at Cork University Hospital one day after collection, as documented on the paper request card, and was promptly centrifuged. Analysis was delayed for three days due to operational constraints and serum indices were run at the same time as the biochemical analyses. Results showed a moderately haemolysed specimen with remarkably low concentrations of both sodium (119 mmol/L) and total calcium (1.15 mmol/L), with all other parameters within their appropriate reference intervals (RIs). The complete report was released electronically and both sodium and calcium results were phoned to, and acknowledged by, the requesting general practitioner (GP). Discussion between the medical scientists and clinical biochemist on duty raised the possibility that the specimen was significantly older than initially thought. Further discussion of results with the GP clarified that the documented time of collection corresponded with specimen receipt by the courier, rather than the time of phlebotomy. Thus, the specimen was 7 days old when received in the laboratory and 10 days old when analysed. This case illustrates the dangers of multiple convergent preanalytical errors. Laboratories should be mindful of the stability of analytes in unseparated blood and unusual patterns of results which might suggest a specimen is “old”, and that this may coexist with erroneous request information. Any potential adverse effects on patient care were prevented in this case by laboratory vigilance.

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The preanalytical phase – Past, present and future

Cited by 8 publications

References 21 publications

Development of a virtual classroom for pre-analytical phase of laboratory medicine for undergraduate medical students using the Delphi technique

Development of a virtual classroom for pre-analytical phase of laboratory medicine for undergraduate medical students using the Delphi technique

The rise in preanalytical errors during COVID-19 pandemic

Case report of spuriously low sodium and calcium in a 36-year-old male in primary care

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