Hawkins R. Managing the pre- and post-analytical phases of the total testing process. *Correspondence: Jerold C. Alcantara, Department of Medical Laboratory Science, College of Applied Medical Sciences, University of Hail, PO Box 2440 Hail, Saudi Arabia (e-mail: [emailprotected]). [24], Interestingly, unauthorized order was remarkably high in ED. Elsevier; 2019:3959. . The pre-analytical phase comprises all processes from the time a laboratory request is made by a physician until the specimen is analyzed at the lab. Preanalytical Phase Errors: Experience of a Central Laboratory. Stumptner C, Stadlbauer V, O'Neil D, Gessner A, Hiergeist A, Zatloukal K, Abuja PM. SAGE Open Med. Data from recent studies suggest that the highest incidence of laboratory-related errors occurs in the pre-analytical phase of laboratory testing. eCollection 2020. The pre-analytical phase comprises all processes from the time a laboratory . Careers. These include inappropriate tests that have been ordered, improper sample collection, transport delays, and illegible handwriting on requisition slips. Federal government websites often end in .gov or .mil. The present study was undertaken with an objective to evaluate different types and frequencies of Pre-analytical and post analytical errors in hematology laboratory of a tertiary care hospital. Epub 2013 Jul 29. The majority of preanalytical errors in the study include nonreceived samples (30.7%) and hemolysis (29.2%). Patient safety and medical diagnosis of patients are mainly influenced by laboratory results. Spanish Preanalytical Quality Monitoring Program (SEQC), an overview of 12 years experience. The provision of an expert-driven interpretation by laboratory professionals resulted in improvements both in the time to and the accuracy of diagnosis. The preanalytical errors refer to all of the inappropriate performances before the specimens are measured by analyzers, such as improper sample collection, transport delays, illegible handwriting on requisition, and so on. Indian J Clin Biochem. Hemolysis of samples occurs when blood is forced through a fine needle, shaking the tubes vigorously, and centrifuging the sample specimens before clotting is complete.4 Red top vacutainers without any anticoagulant should not be shaken after the sample has been collected, and vacutainers for plasma should be gently inverted a few times so the anticoagulant mixes with the blood. Hence, many patients give samples in non-fasting states leading to erroneous reporting. It is clear from the above discussion that incorrect phlebotomy practices are the main reason behind preanalytical errors. Search for other works by this author on: Governmental perspectives on evaluating laboratory performance, Errors in a stat laboratory: Types and frequencies 10 years later. Am J Gastroenterol. In: Accurate Results in the Clinical Laboratory. 1 The preanalytical phase comprises all of the processes occurring before the sample is processed in the autoanalyzer. These include inappropriate tests that have been ordered, improper sample collection, transport delays, and illegible handwriting on requisition slips. Wan Azman WN, Omar J, Koon TS, et al. The overall leading preanalytical errors were nonreceived sample (3.7%) and hemolysis (3.5%). [5]. doi: 10.7759/cureus.7335. Optimizing the management of analytical interferences affecting red blood cells on XN-10 (Sysmex). official website and that any information you provide is encrypted Risk management in laboratory medicine: quality assurance programs and professional competence, Point-of-care testing, medical error, and patient safety: a 2007 assessment, Blood gas and patient safety: considerations based on experience developed in accordance with the Risk Management perspective, The role of in vitro diagnostic companies in reducing laboratory error, Application of the Six Sigma concept in clinical laboratories: a review, One hundred years of laboratory testing and patient safety. Using the laboratory information system, the data of all unacceptable, rejected specimens and canceled tests in the clinical chemistry laboratory was retrieved and analyzed for preanalytical errors following the approval of the study protocol by the Research Ethics Committee and permission from laboratory director. Simundic AM, Church S, Cornes MP, et al. Unable to load your collection due to an error, Unable to load your delegates due to an error. Pre-analytical errors. may email you for journal alerts and information, but is committed Other common errors with post-analytical test results include: Diagnostic algorithms providing guidance for test selection in specific disorders are also used as the basis for the establishment of reflex protocols in the clinical laboratory. 2007;45(6):708-11. doi: 10.1515/CCLM.2007.169. Lipemic samples can arise due to collection after heavy meals or the presence of some metabolic disorder (hyperlipoproteinemias). Together they form a unique fingerprint. It is the responsibility of the clinicians and the phlebotomists to ensure that proper patient preparation is instituted before sample collection. [7] Similar studies also found that inappropriate sample containers, insufficient sample volume, specimen handling, storage, and transportation were among the common errors. Ranjna Chawla and others, Identification of the Types of Preanalytical Errors in the Clinical Chemistry Laboratory: 1-Year Study at G.B. [22] Based on this, it appears that specimen or blood collections from the other departments (ED and IPD) were done by more trained and experienced clinical staff. [26,27] The foremost step in enhancing the quality of the preanalytical phase is to define potential errors and evaluate which errors pose a danger for the outcome of the patient. The distribution of the various preanalytical variables is depicted in Table 2. [8]. February 26, 2020. Approval of the study protocol was obtained from the University of Hail, Research Ethics Committee (H-2021-247). If we consider all the errors in a consolidated manner, then the error rate for preanalytical variables in our clinical biochemistry lab was found to be 1.5%. We have a centralized collection center where samples for clinical biochemistry, hematology, microbiology, and gastroenterology are collected simultaneously. 8600 Rockville Pike This site needs JavaScript to work properly. The most frequent error encountered during processing was that of insufficient volume with an incidence of 0.37%. Corresponding author: Michael Laposata, MD, PhD, Massachusetts General Hospital, 55 Fruit Street, GRJ 235, Boston, MA 02114, USA Phone: +1-617-7268172, Fax: +1-617-7263256, Laposata, Michael and Dighe, Anand. Am J Clin Pathol. Another factor leading to rejection of blood samples in our study was insufficient blood volume. Vol. Bonini Errors in this phase pose serious consequences and potentially compromise the correct diagnosis and management of patients. 2017 Jan 20;12(1):e0170211. The majority of errors in TTP originate in the pre-analytical phase, being due to individual or system design defects. A number of recommendations have been issued [ 6 , 9 , 11 , 12 , 16 , 17 , 20 ]; detailed information can also be found in the RiliBK and DIN EN ISO 15189 (Chapter 36 and 38 ). Please enable it to take advantage of the complete set of features! The clinical biochemistry department is equipped with a state-of-the-art autoanalyzer with ISEOlympus AU 400 (Hamburg, Germany), electrolyte analyzerEcolyte (Ecshweiler, Germany), and other ancillaries for sample processing. Post-analytical errors can also occur during data transmission. The site is secure. Hemolyzed specimens: major challenge for identifying and rejecting specimens in clinical laboratories. Ann Clin Biochem. nurses and physicians), who are neither so skilled nor educated for laboratory work as laboratory professionals. Clin Chem Lab Med. In contrast, literature studies provide excellent evidence that EDs have a higher incidence of hemolysis than other wards or outpatient phlebotomy services. The site is secure. sharing sensitive information, make sure youre on a federal Even at the post-analytics phase, errors can still occur. Conceptualization: Jerold C. Alcantara, Khalid Alshaghdali, Bandar Alharbi. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Factors Affecting Quality of Laboratory Result During Ordering, Handling, and Testing of the Patient's Specimen at Hawassa University College of Medicine and Health Science Comprehensive Specialized Hospital. [7] Emergency and inpatient departments represent a large number of samples received, high workload pressures, more challenging group, and more difficulty in collecting blood samples. J Lab Physicians. Available at: [10]. A total of 55,345 laboratory requests and samples from different departments and wards were evaluated for preanalytical errors. Analysis of the annual preanalytical errors revealed an increasing rate in the OPD and IPD, whereas a decreasing rate was observed in the ED (Table 3). In a study of preanalytic errors, 47 percent of the errors were due to inadequate sample quality followed by wrong patient identification (26.8 percent), a missing physician order (14 percent), inappropriate sample quantity (11.6 percent), and inappropriate container (0.6 percent). This study underscores the need for quality controls and quality assurance in the preanalytical phase to monitor existing errors to improve patient safety and laboratory diagnosis. [4]. Patient safety and the medical diagnosis of patients are mainly influenced by laboratory results. Characterization and mathematical correction of hemolysis interference in selected Hitachi 717 assays, Chemistry specimen acceptability: A College of American Pathologists Q-Probes study of 453 laboratories, Identification of preanalytical mistakes in the stat section of the clinical laboratory, Complete blood count specimen acceptability: A College of American Pathologists Q-Probes study of 703 laboratories, Task analysis revisited: Refining the phlebotomy technician scope of practice and assessing longitudinal change in competencies, Causes, consequences, detection and prevention of identification errors in laboratory diagnostics, American Society of Clinical Pathologists, A novel high-resolution melting analysis strategy for detecting cystic fibrosiscausing variants, Clinical impacts of the rapid diagnostic method on positive blood cultures, Nitrate Reductase Assay for Rapid Determination of Methicillin-Resistant Staphylococcus aureus Clinical Isolates, Relationship between the systemic immune-inflammatory index and the severity of acute bronchiolitis in children, About the American Society for Clinical Pathology, Receive exclusive offers and updates from Oxford Academic, Evaluation of the Preanalytical Interference of Hemoglobin, Bilirubin, or Lipids in Therapeutic Drug Monitoring Assays on Beckman Coulter AU Analyzers, From A to AB: A Caucasian Mother with High Anti-B Titer Causing Hemolytic Disease of the Newborn, Intravenous Immunoglobulin-Associated Hemolytic Anemia, Clinical Laboratory Employees Attitudes Toward Artificial Intelligence. Likewise, data from this study can serve as guides in defining new approaches and strategies in decreasing the errors in the preanalytical phase. A survey of physicians who use our clinical laboratory demonstrated that the largest number of test ordering errors appear to involve physicians simply ordering the wrong test. 2009 Jun;404(1):16-23. doi: 10.1016/j.cca.2009.03.022. The preanalytical phase has a significant impact on the quality of laboratory results. 2007;17(1):5-9. The data collection procedure involved review of blood samples received from the inpatient as well as outpatient departments. A P value of .05 was considered statistically significant. [3], A distinct and intricate process within laboratory medicine includes laboratory procedures, instruments, technology, and human skills intended to warrant accurate, precise, and appropriate diagnosis and treatment decisions. EJHaem. Notably, nonreceived samples were the most prevalent in ED (6.1%) and IPD (4.8%), while hemolysis (4.2%) was predominantly observed in OPD. official website and that any information you provide is encrypted The preanalytical phase has a significant impact on the quality of laboratory results. Pre-treatment of rapamycin transformed M2 microglia alleviates traumatic cervical spinal cord injury via AIM2 signaling pathway in vitro and in vivo. Software: Jerold C. Alcantara, Yasser Almotairi, Mohammad Jahoor Alam. In laboratories, analytical errors are mostly all alike: every method has some amount of analytical error, in the form of systematic and random error. But lack of staff training engaged in phlebotomy is an impediment for expediting sample collection and transport. The rate of error in the study was high and the leading causes were nonreceived samples and hemolysis. A survey of physicians who use our clinical laboratory demonstrated that the largest number of test ordering errors appear to involve physicians simply ordering the wrong test. Compliance of blood sampling procedures with the CLSI H3-A6 guidelines: an observational study by the European Federation of. [13] In contrast, the present finding was higher than the studies conducted in Tunisia (7.7%), Ghana (3.7%), Greece (1.94%), and India (0.15%). Keyword Highlighting Validation: Jerold C. Alcantara, Khalid Alshaghdali, Bandar Alharbi, Yasser Almotairi, Abdel Rahim Mahmoud Muddathir, Mohammad Jahoor Alam. FOIA Please enable scripts and reload this page. 2011;47:399408. It has been observed that the clinicians often send incomplete slips with the samples. 2019;6:1979. 2015;25:37785. PLoS One. Inpatient phlebotomies are performed by clinical department staff, whereas blood specimens from outpatients are collected on site at a centralized collection center by laboratory personnel. METHODS The introduction of vacuum tubes along with the closed system of blood collection has made blood collection efficient and easy. The preanalytical phase is the stage of greatest risk but preanalytical errors may go undetected until postanalytical validation and interpretation. Please login or register with De Gruyter to order this product. Lipemia accounted for rejection of 0.03% and 0.11% of the samples in the inpatient and outpatient departments respectively.
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