Aim To identify rates of most common pre-analytical errors and to document possible (different) error rates between inpatients and outpatients. Methods This retrospective study was conducted at the Department of Medical Biochemistry and Immunology Diagnostics, Cantonal Hospital Zenica, from December 2016 until March 2017. Data on rejected blood samples in the laboratory information system were analysed. Results During the 3-month period 35,343 patient blood samples (25,545 inpatients and 9,798 outpatients) were received in the laboratory. The study identified 602 (1.70%) rejected samples because of pre-analytical errors, mostly due to haemolysis, 292 (48.50%), and clotted samples, 240 (39.87%). The remaining 70 (11.63%) samples were rejected because of inappropriate sample volume, inappropriate container and identification errors (7.81%, 2.16% and 1.66%, respectively). The proportion of inpatient rejected samples was 8.7-fold higher than in the outpatient samples. The proportion of inpatient rejected samples because of haemolysis, clotted samples, inappropriate sample volume and inappropriate containers were higher than in the outpatient samples (20.5-, 12.1-, 2.3- and 1.3-fold higher, respectively); proportion of rejected samples because of identification errors was 8.0-fold higher in the outpatient (collection sites outside the hospital) than in the inpatient samples. Conclusion Higher pre-analytical sample error rates were connected with inpatient samples, while higher identification error rates were connected with outpatient samples. Establishment of periodic stuff training and introduction of information technology could reduce pre-analytical errors.
Tehrani S, Lee A, Mathews H, Shore S, Makary A, Pronovost M, et al. 25-Year summary of US malpractice claims for diagnostic errors 1986-2010: an analysis from the National Practitioner Data Bank. BMJ Qual Saf. 2013. p. 672–80.
2.
Singh H, Giardina T, Meyer A, Forjuoh S, Reis M, Thomas E. Types and origins of diagnostic errors in primary care settings. JAMA Intern Med. 2013. p. 418–25.
3.
Singh H, Graber M, Kissam S, Sorensen A, Lenfestey N, Tant E, et al. System-related interventions to reduce diagnostic errors: a narrative review. BMJ Qual Saf. 2012. p. 160–70.
4.
Plebani M, Task. Force on Performance Specifications for the extra-analytical phases. Performance specifications for the extra-analytical phases of laboratory testing: why and how. Clin Biochem. 2017. p. 550–4.
5.
International Organization for Standardization. 2012.
6.
International Organization for Standardization. 2012.
7.
Plebani M. Errors in laboratory medicine and patient safety: the road ahead. Clin Chem Lab Med. 2007. p. 700–7.
8.
Plebani M, Sciacovelli L, Aita A, Chiozza M. Harmonization of pre-analytical quality indicators. Biochem Med. 2014. p. 105–13.
9.
Plebani M. The detection and prevention of errors in laboratory medicine. Ann Clin Biochem. 2010. p. 101–10.
10.
Sciacovelli L, Lippi G, Sumarac Z, West J, Del Pino Castro G, I, et al. Laboratory Errors and Patient Safety" of International Federation of Clinical Chemistry and Laboratory Medicine (IFCC). Quality Indicators in Laboratory Medicine: the status of the progress of IFCC Working Group “Laboratory Errors and Patient Safety” project. Clin Chem Lab Med. 2017. p. 348–57.
11.
Plebani M. Quality indicators to detect pre-analytical errors in laboratory testing. Clin Biochem Rev. 2012. p. 85–8.
12.
Plebani M, Sciacovelli L, Marinova M, Marcuccitti J, Chiozza M. Quality indicators in laboratory medicine: a fundamental tool for quality and patient safety. Clin Biochem. 2013. p. 1170–4.
13.
Atay A, Demir L, Cuhadar S, Saglam G, Unal H, Aksun S, et al. Clinical biochemistry laboratory rejection rates due to various types of preanalytical errors. Biochem Med. 2014. p. 376–82.
14.
Alsina M, Alvarez V, Barba N, Bullich S, Cortes M, Escoda I, et al. Preanalytical quality control program -an overview of results (2001-2005 summary). Clin Chem Lab Med. 2008. p. 849–54.
15.
Stark A, Jones B, Chapman D, Well K, Krajenta R, Meier F, et al. Clinical laboratory specimen rejection: association with the site of patient care and patients’ characteristics: findings from a single health care organization. Arch Pathol Lab Med. 2007. p. 588–92.
16.
Lippi G, Blanckaert N, Bonini P, Green S, Kitchen S, Palicka V, et al. Causes, consequences, detection, and prevention of identification errors in laboratory diagnostics. Clin Chem Lab Med. 2009. p. 143–53.
17.
Wagar E, Tamashiro L, Yasin B, Hilborne L, Bruckner D. Patient safety in the clinical laboratory: a longitudinal analysis of specimen identification errors. Arch Pathol Lab Med. 2006. p. 1662–8.
18.
Dunn E, Moga P. Patient misidentification in laboratory medicine: a qualitative analysis of 227 root cause analysis reports in the Veterans’ Health Administration. Arch Pathol Lab Med. 2010. p. 244–55.
19.
Snyder S, Favoretto A, Derzon J, Christenson R, Kahn S, Shaw C, et al. Effectiveness of barcoding for reducing patient specimen and laboratory testing identification errors: A Laboratory Medicine Best Practices systematic review and meta-analysis. Clin Biochem. 2012. p. 988–98.
20.
Dikmen Z, Pinar A, Akbiyik F. Specimen rejection in laboratory medicine: Necessary for patient safety. Biochem Med. 2015. p. 377–85.
21.
Grecu D, Vlad D, Dumitrascu V. Quality indicators in the preanalytical phase of testing in a stat laboratory. Lab Med. 2014. p. 74–81.
22.
Lippi G, Blanckaert N, Bonini P, Green S, Kitchen S, Palicka V, et al. Haemolysis: an overview of the leading cause of unsuitable specimens in clinical laboratories. Clin Chem Lab Med. 2008. p. 764–72.
23.
Carraro P, Servidio G, Plebani M. Hemolyzed specimens: a reason or rejection or a clinical challenge? Clin Chem. 2000. p. 306–8.
24.
Procedures for the handling and processing of blood specimens for common laboratory tests. CLSI H18-A4 document. 2010.
25.
Tubes and additives for venous and capillary blood specimen collection (H01-A6); Approved Standard -Sixth Edition. 2010.
26.
Schnabl K, Chan M, Gong Y, Adeli K. Closing the gaps in pediatric reference intervals: the CALIPER Initiative. Clin Biochem Rev. 2008. p. 89–96.
27.
Wallin O, Söderberg J, Van Guelpen B, Stenlund H, Grankvist K, Brulin C. Preanalytical venous blood sampling practices demand improvement -a survey of test-request management, test-tube labelling and information search procedures. Clin Chim Acta. 2008. p. 91–7.
28.
Lillo R, Salinas M, Lopez-Garrigos M, Naranjo-Santana Y, Gutierrez M, Marin M, et al. Reducing preanalytical laboratory sample errors through educational and technological interventions. Clin Lab. 2012. p. 911–7.
29.
Li Y, Yang H, Huang Y, Li W, Song Y, Chen P, et al. Reduction of preanalytical errors in laboratory by establishment and application of training system. J Evid Based Med. 2014. p. 258–62.
30.
Accuracy in patient and sample identification; approved guideline. 2010.
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